Provider Demographics
NPI:1073553301
Name:PERICH, ANDREW CHARLES (PT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:CHARLES
Last Name:PERICH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3340
Mailing Address - Street 2:NEW VALLEY REHAB
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18043-3340
Mailing Address - Country:US
Mailing Address - Phone:484-851-3386
Mailing Address - Fax:484-851-3469
Practice Address - Street 1:3560 ROUTE 309
Practice Address - Street 2:ST LUKES PHYSICAL THERAPY
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069-2001
Practice Address - Country:US
Practice Address - Phone:610-366-8502
Practice Address - Fax:610-366-8508
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50018519OtherCAPITAL
PT015788OtherUS DEPT OF LABOR
PA1436633OtherHIGHMARK
1436633OtherBLUE SHIELD PA HIGHMARK
3336072OtherHMO
50018519OtherCAPITAL ADVANTAGE BLUE CR
7524519OtherPPO
1436633OtherPPO PERSONAL CHOICE
20034125OtherAMERIHEALTH MERCY
2120963000OtherHMO KEYSTONE EAST