=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194805341
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NELDA F PERRY PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2204 ROBIN AVE
-----------------------------------------------------
City | HAMMOND
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70403-5751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-542-7878
-----------------------------------------------------
Fax | 985-542-4396
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P O BOX 2965
-----------------------------------------------------
City | HAMMOND
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-542-7878
-----------------------------------------------------
Fax | 985-542-4396
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | PTA7016
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------