Healthcare Provider Details

I. General information

NPI: 1457793606
Provider Name (Legal Business Name): MICHELLE PERRY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRAINTREE ST.
ALLSTON MA
02134-1956
US

IV. Provider business mailing address

1 BRAINTREE ST ST
ALLSTON MA
02134-1956
US

V. Phone/Fax

Practice location:
  • Phone: 617-787-8700
  • Fax: 617-787-8106
Mailing address:
  • Phone: 617-787-8700
  • Fax: 617-787-8106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20750
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: