Healthcare Provider Details

I. General information

NPI: 1740226679
Provider Name (Legal Business Name): SAUNDRA J PERRY RPT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57190 MAIN RD
SOUTHOLD NY
11971-4750
US

IV. Provider business mailing address

57190 MAIN RD PO BOX 1824
SOUTHOLD NY
11971-4750
US

V. Phone/Fax

Practice location:
  • Phone: 631-765-3620
  • Fax: 631-765-0013
Mailing address:
  • Phone: 631-765-3620
  • Fax: 631-765-0013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number06894
License Number StateNY

VIII. Authorized Official

Name: MS. SAUNDRA J PERRY
Title or Position: OWNER/CEO
Credential: P.T..
Phone: 631-765-3620