Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1568747772 |
---|---|
Provider Name | Mr. Michael Troy Perryman |
First Address | Gilbert, AZ 85295-2140 |
Second Address | Gilbert, AZ 85295-2140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2011 |
Last Update Date | 07/05/2012 |