Provider Demographics
NPI:1831404037
Name:PERKINS, KAMI RAE (PTA)
Entity type:Individual
Prefix:MS
First Name:KAMI
Middle Name:RAE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:KAMI
Other - Middle Name:RAE
Other - Last Name:EBENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1401 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-2315
Mailing Address - Country:US
Mailing Address - Phone:815-968-4400
Mailing Address - Fax:815-490-5858
Practice Address - Street 1:209 9TH ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2235
Practice Address - Country:US
Practice Address - Phone:815-968-4400
Practice Address - Fax:815-490-5858
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160004307225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant