Provider Demographics
NPI:1083901508
Name:PERRY, CRAIG V (PT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:V
Last Name:PERRY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3831 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1859
Mailing Address - Country:US
Mailing Address - Phone:702-876-1733
Mailing Address - Fax:702-878-2018
Practice Address - Street 1:8925 W RUSSELL RD
Practice Address - Street 2:SUITE 140
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1219
Practice Address - Country:US
Practice Address - Phone:702-914-6787
Practice Address - Fax:702-914-6885
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV2570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVFK733ZMedicare PIN