Provider Demographics
NPI:1295885283
Name:PIERCE, JACQUELINE FASULO (PT)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:FASULO
Last Name:PIERCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-1103
Mailing Address - Country:US
Mailing Address - Phone:508-643-4603
Mailing Address - Fax:
Practice Address - Street 1:208 COLLYER ST
Practice Address - Street 2:PULMONARY REHAB
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1560
Practice Address - Country:US
Practice Address - Phone:401-793-4080
Practice Address - Fax:401-793-4110
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI007542251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary