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General NPI Number Information
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NPI Number | 1982173886
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Entity Type | Individual
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Provider Name | ZACH PERRY
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Gender | Male
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Dates
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Enumeration Date | 11/20/2018
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Last Update Date | 11/20/2018
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Provider Practice Location Address
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Address Line | 16941 N EAGLE RIVER LOOP RD STE 3
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City | EAGLE RIVER
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State | AK
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Zip | 99577-7824
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Country | US
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Telephone | 907-726-5330
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Fax |
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Provider Business Mailing Address
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Address Line | 23464 NORTHWOODS CIR
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City | CHUGIAK
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State | AK
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Zip | 99567-5467
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Legacy Identifiers
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Identifier #1
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Identifier Code | RBT-18-0000
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | TRI-CARE
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | RBT-18-0000
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | TRI-CARE
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