Healthcare Provider Details

I. General information

NPI: 1669827481
Provider Name (Legal Business Name): JAMES PERRY PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 W CONWAY RD
HARBOR SPRINGS MI
49740-9684
US

IV. Provider business mailing address

1171 W CONWAY RD
HARBOR SPRINGS MI
49740-9684
US

V. Phone/Fax

Practice location:
  • Phone: 231-487-6163
  • Fax:
Mailing address:
  • Phone: 231-487-6163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502004862
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: