MEDICARE: MISS ANNETTE MARIE PERRY P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	167G00000X	Licensed Psychiatric Technician	PT30136	CA

General Provider Information

NPI Number	:	1659406577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANNETTE MARIE PERRY P.T.

Provider Business Mailing Address
First Line	:	3915 CENTER ST
Second Line	:	APT C
City	:	BALDWIN PARK
State	:	CA
Zip	:	91706-2918
Country	:	US
Telephone Number	:	626-485-2220
Fax Number	:

Provider Business Practice Location Address
First Line	:	3915 CENTER ST
Second Line	:	APT C
City	:	BALDWIN PARK
State	:	CA
Zip	:	91706-2918
Country	:	US
Telephone Number	:	626-485-2220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/08/2007

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