Healthcare Provider Details

I. General information

NPI: 1528849874
Provider Name (Legal Business Name): PAT PERRY PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 WATER ST
DAWSON SPRINGS KY
42408-1727
US

IV. Provider business mailing address

554 LADD RD
EDDYVILLE KY
42038-7853
US

V. Phone/Fax

Practice location:
  • Phone: 270-797-2025
  • Fax:
Mailing address:
  • Phone: 270-839-3292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA02054
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: