Provider Demographics
NPI:1427083716
Name:PERKINS, CHAD IAN (MS, ATC)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:IAN
Last Name:PERKINS
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 CHICKASAW RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-2707
Mailing Address - Country:US
Mailing Address - Phone:662-236-5802
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF INTERCOLLEGATE ATHLETICS
Practice Address - Street 2:RM.118 FIELDHOUSE
Practice Address - City:UNIVERSITY
Practice Address - State:MS
Practice Address - Zip Code:38677
Practice Address - Country:US
Practice Address - Phone:662-915-7536
Practice Address - Fax:662-915-5275
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT03532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer