Provider Demographics
NPI:1073730578
Name:PERRY, KEVIN MAURICE (PT, ATC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:MAURICE
Last Name:PERRY
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 N PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-3078
Mailing Address - Country:US
Mailing Address - Phone:405-780-9919
Mailing Address - Fax:405-780-9920
Practice Address - Street 1:2270 N PERKINS RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-3078
Practice Address - Country:US
Practice Address - Phone:405-780-9919
Practice Address - Fax:405-780-9920
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT1799174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist