Provider Demographics
NPI:1376047464
Name:PEREYRA, CARRIE PUALANILEIMAKAMAE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:PUALANILEIMAKAMAE
Last Name:PEREYRA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 W 1150 N
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-4212
Mailing Address - Country:US
Mailing Address - Phone:808-640-4955
Mailing Address - Fax:
Practice Address - Street 1:BRIGHAM YOUNG UNIVERSITY
Practice Address - Street 2:173 RICHARDS BUILDING
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84602
Practice Address - Country:US
Practice Address - Phone:801-422-1628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer