Provider Demographics
NPI:1013480847
Name:PEREIRA, AMY RUTH
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:RUTH
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SUGARBUSH LN
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3159
Mailing Address - Country:US
Mailing Address - Phone:508-524-0127
Mailing Address - Fax:
Practice Address - Street 1:12 SUGARBUSH LN
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-3159
Practice Address - Country:US
Practice Address - Phone:508-524-0127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8721225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant