Healthcare Provider Details

I. General information

NPI: 1255675658
Provider Name (Legal Business Name): PERRY CLIFTON ST. JOHN LPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 COUNTY ROAD 483
HANCEVILLE AL
35077
US

IV. Provider business mailing address

440 COUNTY ROAD 483
HANCEVILLE AL
35077-8002
US

V. Phone/Fax

Practice location:
  • Phone: 256-507-0841
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number229
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: