Provider Demographics
NPI:1992941009
Name:PERRY, JAMES EDWARD JR (PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
Last Name:PERRY
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:PO BOX 4499
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-4499
Mailing Address - Country:US
Mailing Address - Phone:714-367-5310
Mailing Address - Fax:714-367-5381
Practice Address - Street 1:5722 BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-1422
Practice Address - Country:US
Practice Address - Phone:562-920-8394
Practice Address - Fax:562-867-6083
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 10161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC502ZMedicare PIN
CADC502YMedicare PIN