Healthcare Provider Details

I. General information

NPI: 1215761762
Provider Name (Legal Business Name): DINAH JOANN PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WOODLAND AVE
PHILADELPHIA PA
19104-4551
US

IV. Provider business mailing address

3058 N BAMBREY ST
PHILADELPHIA PA
19132-1301
US

V. Phone/Fax

Practice location:
  • Phone: 215-823-5800
  • Fax:
Mailing address:
  • Phone: 215-300-0465
  • Fax: 267-930-3685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number199004
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: