=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659414472
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. LOUIS ANTHONY PERRY II
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2002 ROCK WAY
-----------------------------------------------------
City | HOLLAND
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18966-2877
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-944-1151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 SECKELPEAR RD
-----------------------------------------------------
City | LEVITTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19056-1704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-945-4643
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | RT000491A
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------