Provider Demographics
NPI:1992290407
Name:PINEAU, CARA A (DPT)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:A
Last Name:PINEAU
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:
Other - Last Name:PINEAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:1181 AQUIDNECK AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5255
Mailing Address - Country:US
Mailing Address - Phone:401-845-0840
Mailing Address - Fax:401-619-3752
Practice Address - Street 1:652 WOOD ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809
Practice Address - Country:US
Practice Address - Phone:401-396-9581
Practice Address - Fax:401-619-3752
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
RIPT03106225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPT03106OtherLICENSE