Healthcare Provider Details

I. General information

NPI: 1487157640
Provider Name (Legal Business Name): PERRI RISEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 SHERBURN CT
ORLANDO FL
32828-9017
US

IV. Provider business mailing address

606 SHERBURN CT
ORLANDO FL
32828-9017
US

V. Phone/Fax

Practice location:
  • Phone: 407-810-2773
  • Fax: 407-867-6203
Mailing address:
  • Phone: 407-810-2773
  • Fax: 407-867-6203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA27716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: