Healthcare Provider Details

I. General information

NPI: 1497465801
Provider Name (Legal Business Name): CHARLEMAE AVA PERKINS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHARLEMAE AVA GAST

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6438 WILMINGTON PIKE STE 230
CENTERVILLE OH
45459-7021
US

IV. Provider business mailing address

3589 MARWOOD DR
BELLBROOK OH
45305-7553
US

V. Phone/Fax

Practice location:
  • Phone: 937-558-3810
  • Fax:
Mailing address:
  • Phone: 937-999-8179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number016356
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: