Provider Demographics
NPI:1194805341
Name:PERRY, NELDA F (PTA)
Entity type:Individual
Prefix:MS
First Name:NELDA
Middle Name:F
Last Name:PERRY
Suffix:
Gender:F
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:P O BOX 2965
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404
Mailing Address - Country:US
Mailing Address - Phone:985-542-7878
Mailing Address - Fax:985-542-4396
Practice Address - Street 1:2204 ROBIN AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5751
Practice Address - Country:US
Practice Address - Phone:985-542-7878
Practice Address - Fax:985-542-4396
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPTA7016225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1677485Medicaid
LA6400001OtherUNITED HEALTHCARE
LAPTA7016OtherPHYSICAL THERAPY ASSIST.
LAPTA7016Medicare UPIN
LA196596Medicare ID - Type UnspecifiedMEDICARE GROUP #