Healthcare Provider Details

I. General information

NPI: 1720861966
Provider Name (Legal Business Name): JERUSHA PERAM PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 PORTLAND RD STE 5
KENNEBUNK ME
04043-6742
US

IV. Provider business mailing address

37 MAIN ST
CONWAY NH
03818-6166
US

V. Phone/Fax

Practice location:
  • Phone: 207-985-6181
  • Fax:
Mailing address:
  • Phone: 603-447-2533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02196100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7464
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT44221
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP048807T
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: