Provider Demographics
NPI:1033311907
Name:PEROUTKY, ANDREW RAYMOND (RCP RRT CRTT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:RAYMOND
Last Name:PEROUTKY
Suffix:
Gender:M
Credentials:RCP RRT CRTT
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:16083 GUNFLINT CIR
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5252
Mailing Address - Country:US
Mailing Address - Phone:952-431-1860
Mailing Address - Fax:
Practice Address - Street 1:16083 GUNFLINT CIR
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-5252
Practice Address - Country:US
Practice Address - Phone:952-431-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN16912279P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Rehabilitation