Provider Demographics
NPI:1316754179
Name:PERRY, IREAN IRITZ
Entity type:Individual
Prefix:
First Name:IREAN
Middle Name:IRITZ
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14528 LANICA CIRCLE
Mailing Address - Street 2:14595 AVION PARKWAY,
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151
Mailing Address - Country:US
Mailing Address - Phone:571-290-2775
Mailing Address - Fax:
Practice Address - Street 1:14528 LANICA CIRCLE
Practice Address - Street 2:14595 AVION PARKWAY,
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151
Practice Address - Country:US
Practice Address - Phone:571-290-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019019493225700000X
0019019493225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist