MEDICARE: JACQUELYN PERROTT

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	225100000X	Physical Therapist	PT020735	OH

General Provider Information

NPI Number	:	1689448565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN PERROTT

Provider Business Mailing Address
First Line	:	2876 GALWAY DR
Second Line	:
City	:	BRUNSWICK
State	:	OH
Zip	:	44212-4238
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	197 N LEAVITT RD
Second Line	:
City	:	AMHERST
State	:	OH
Zip	:	44001-1110
Country	:	US
Telephone Number	:	440-320-7439
Fax Number	:

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

Provider Enumeration Date	:	11/10/2023
Last Update Date	:	11/10/2023

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Directions to “ JACQUELYN PERROTT ” Practice Location

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