=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952444820
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANICE M PERKINS PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2202 HEALTH PROFESSIONS BUILDING
-----------------------------------------------------
City | MT PLEASANT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48859-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-774-1297
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3658 CYPRESS RD
-----------------------------------------------------
City | REMUS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49340-9732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-561-5408
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 5501009211
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------