Provider Demographics
NPI:1932184819
Name:PERRY, ELIZABETH A (PT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:A
Last Name:PERRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 5717
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92248-5717
Mailing Address - Country:US
Mailing Address - Phone:760-343-5062
Mailing Address - Fax:
Practice Address - Street 1:44025 JEFFERSON ST
Practice Address - Street 2:STE 104
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-4874
Practice Address - Country:US
Practice Address - Phone:760-345-5453
Practice Address - Fax:760-345-7063
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 22714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT227140Medicare PIN
CA0PT227141Medicare PIN