Provider Demographics
NPI:1093123358
Name:CARRERAS, MARIE (DPT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:CARRERAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4 RICHMOND SQ STE 200
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5117
Mailing Address - Country:US
Mailing Address - Phone:401-433-4172
Mailing Address - Fax:401-433-0612
Practice Address - Street 1:115 NORWOOD PARK S
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-4633
Practice Address - Country:US
Practice Address - Phone:781-702-4630
Practice Address - Fax:781-702-4510
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0115262251P0200X
MAPTL19709225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics