Healthcare Provider Details

I. General information

NPI: 1467783860
Provider Name (Legal Business Name): HOLLY PERRY MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3341 E QUEEN CREEK RD SUITE 109
GILBERT AZ
85297-8503
US

IV. Provider business mailing address

3341 E QUEEN CREEK RD SUITE 109
GILBERT AZ
85297-8503
US

V. Phone/Fax

Practice location:
  • Phone: 480-621-8361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License NumberB14896096
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: