Healthcare Provider Details

I. General information

NPI: 1215202916
Provider Name (Legal Business Name): PERRY THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 COUNTY HIGHWAY 147 W
LAUREL HILL FL
32567-3233
US

IV. Provider business mailing address

630 COUNTY HIGHWAY 147 W
LAUREL HILL FL
32567-3233
US

V. Phone/Fax

Practice location:
  • Phone: 850-834-4961
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number2274
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: