Provider Demographics
NPI:1154478782
Name:PERRIN, DAVID CHARLES (MS PT, ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CHARLES
Last Name:PERRIN
Suffix:
Gender:M
Credentials:MS PT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 SANDBURR DR
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-9463
Mailing Address - Country:US
Mailing Address - Phone:616-667-2785
Mailing Address - Fax:616-608-7786
Practice Address - Street 1:1935 SANDBURR DR
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-9463
Practice Address - Country:US
Practice Address - Phone:616-667-2785
Practice Address - Fax:616-608-7786
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010589225100000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer