Basic Information
| Provider Information | |||||||||
| NPI: | 1033305958 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERALTA | ||||||||
| FirstName: | CARY | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 418871 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022418871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018561682 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8116 GOOD LUCK RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LANHAM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207063502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015524131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2007 | ||||||||
| LastUpdateDate: | 01/26/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 20583 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 2305204067 | VA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 870186 | DC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.