Healthcare Provider Details

I. General information

NPI: 1043164155
Provider Name (Legal Business Name): AVA RENEE PERRIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N JOHN R WOODEN DR
WEST LAFAYETTE IN
47907-2117
US

IV. Provider business mailing address

5212 GRAPEVINE DR
WEST LAFAYETTE IN
47906-9044
US

V. Phone/Fax

Practice location:
  • Phone: 800-497-7678
  • Fax:
Mailing address:
  • Phone: 765-404-3605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: