Provider Demographics
NPI:1083265219
Name:PERRY, BHAVISHA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:BHAVISHA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:MRS
Other - First Name:BHAVISHA
Other - Middle Name:
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BHAVISHA ACHARYA
Mailing Address - Street 1:14135 85TH RD APT 6A
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2565
Mailing Address - Country:US
Mailing Address - Phone:646-363-7236
Mailing Address - Fax:
Practice Address - Street 1:14135 85TH RD APT 6A
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-2565
Practice Address - Country:US
Practice Address - Phone:646-363-7236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-29
Last Update Date:2019-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023089225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist