Provider Demographics
NPI:1427116987
Name:PERUGINI, ELISABETH ANN (PT)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:ANN
Last Name:PERUGINI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 WYOMING AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-1366
Mailing Address - Country:US
Mailing Address - Phone:570-288-1734
Mailing Address - Fax:570-288-1735
Practice Address - Street 1:1150 WYOMING AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-1366
Practice Address - Country:US
Practice Address - Phone:570-288-1734
Practice Address - Fax:570-288-1735
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014396950002Medicaid
PA11510478OtherCAQH UNIVERSAL CREDENTIAL
PA1014396950001Medicaid
PA7510777OtherAETNA PROVIDER ID NUMBER