MEDICARE: MRS. TAMMY MARIE PERRY PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	116577	MO

General Provider Information

NPI Number	:	1023668027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMMY MARIE PERRY PTA

Provider Business Mailing Address
First Line	:	1307 NW PECAN DR
Second Line	:
City	:	GRAIN VALLEY
State	:	MO
Zip	:	64029-3706
Country	:	US
Telephone Number	:	636-255-4992
Fax Number	:

Provider Business Practice Location Address
First Line	:	2415 AGNES AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64127-4129
Country	:	US
Telephone Number	:	816-418-4872
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2019
Last Update Date	:	09/12/2019

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