Provider Demographics
NPI:1073637070
Name:PERRY PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:PERRY PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:760-345-5453
Mailing Address - Street 1:44025 JEFFERSON ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-4874
Mailing Address - Country:US
Mailing Address - Phone:760-345-5453
Mailing Address - Fax:760-345-7063
Practice Address - Street 1:44025 JEFFERSON ST
Practice Address - Street 2:SUITE 104
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-4874
Practice Address - Country:US
Practice Address - Phone:760-345-5453
Practice Address - Fax:760-345-7063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT227141Medicare PIN