Active NPI
Coral Elizabeth Quinn Perniciaro, D.P.T.
- Physical Therapist
- Dacula, GA
National Provider Identifier
1588093439
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT011125
- Practice address
- 3635 Braselton Hwy
Suite C
Dacula, GA 30019-1068 - Phone
- (770) 932-4332
- Fax
- (470) 238-3050
- NPI assigned
- Nov 1, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT011125 | GA | Primary |
Addresses
Primary practice location
3635 Braselton Hwy
Suite C
Dacula, GA 30019-1068
Mailing address
3635 Braselton Hwy
Suite C
Dacula, GA 30019-1068
Phone (770) 932-4332
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT011125 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400716800000",
"number": "1588093439",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3635 BRASELTON HWY",
"address_2": "SUITE C",
"city": "DACULA",
"state": "GA",
"postal_code": "300191068",
"telephone_number": "770-932-4332",
"fax_number": "470-238-3050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3635 BRASELTON HWY",
"address_2": "SUITE C",
"city": "DACULA",
"state": "GA",
"postal_code": "300191068",
"telephone_number": "770-932-4332",
"fax_number": "470-238-3050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERNICIARO",
"first_name": "CORAL",
"middle_name": "ELIZABETH QUINN",
"name_prefix": "Mrs.",
"credential": "D.P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-11-01",
"last_updated": "2014-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT011125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dacula, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.