Healthcare Provider Details

I. General information

NPI: 1437356458
Provider Name (Legal Business Name): DONNA L PERDEW PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 MAITLAND AVE
TEANECK NJ
07666-3025
US

IV. Provider business mailing address

316 MAITLAND AVE
TEANECK NJ
07666-3025
US

V. Phone/Fax

Practice location:
  • Phone: 201-833-0234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberQA00428900
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: