Basic Information
| Provider Information | |||||||||
| NPI: | 1992290407 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PINEAU | ||||||||
| FirstName: | CARA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | DPT | ||||||||
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| OtherLastName: | PINEAU | ||||||||
| OtherFirstName: | CARA | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1181 AQUIDNECK AVE | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028425255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018450840 | ||||||||
| FaxNumber: | 4016193752 | ||||||||
| Practice Location | |||||||||
| Address1: | 652 WOOD ST | ||||||||
| Address2: | |||||||||
| City: | BRISTOL | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013969581 | ||||||||
| FaxNumber: | 4016193752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2018 | ||||||||
| LastUpdateDate: | 08/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT03106 | RI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT03106 | 01 | RI | LICENSE | OTHER |