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NPI Code Detail

MEDICARE: MR. JAMES PERRY PTA

MEDICARE: MR. JAMES 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
1225200000XPhysical Therapy Assistant5502004862MI

General Provider Information

NPI Number : 1669827481
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES PERRY PTA
Provider Business Mailing Address
First Line : 1171 W CONWAY RD
Second Line :
City : HARBOR SPRINGS
State : MI
Zip : 49740-9684
Country : US
Telephone Number : 231-487-6163
Fax Number :
Provider Business Practice Location Address
First Line : 1171 W CONWAY RD
Second Line :
City : HARBOR SPRINGS
State : MI
Zip : 49740-9684
Country : US
Telephone Number : 231-487-6163
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2016
Last Update Date : 04/29/2016

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