Provider Demographics
NPI:1104167816
Name:PERRY, CHAD JEFFREY (PTA)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:JEFFREY
Last Name:PERRY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 QUADRUM DRIVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108
Mailing Address - Country:US
Mailing Address - Phone:918-720-4386
Mailing Address - Fax:405-948-1926
Practice Address - Street 1:238 QUADRUM DRIVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108
Practice Address - Country:US
Practice Address - Phone:918-720-4386
Practice Address - Fax:405-948-1926
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1705225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant