Basic Information
| Provider Information | |||||||||
| NPI: | 1124492822 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PACE | ||||||||
| FirstName: | DERYL | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 237 WINTHROP ST | ||||||||
| Address2: | |||||||||
| City: | REHOBOTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027692601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7745650796 | ||||||||
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| Practice Location | |||||||||
| Address1: | 285 GOVERNOR ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029063237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012760800 | ||||||||
| FaxNumber: | 4012760808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2015 | ||||||||
| LastUpdateDate: | 01/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT02871 | RI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.