Provider Demographics
NPI:1972708295
Name:PERRIS, KEVIN WOODSON (PT)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:WOODSON
Last Name:PERRIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WILDFLOWER CIR
Mailing Address - Street 2:STE 903
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9782
Mailing Address - Country:US
Mailing Address - Phone:724-416-3037
Mailing Address - Fax:
Practice Address - Street 1:900 WILDFLOWER CIR STE 903
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9782
Practice Address - Country:US
Practice Address - Phone:724-416-7172
Practice Address - Fax:724-416-3037
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0021972081S0010X
OH100712081S0010X
PA201172081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV002987OtherWV STATE LICENSE
PA020117OtherPA STATE LICENSE
OHANTHEMOther000000168295