Provider Demographics
NPI:1194201186
Name:PERRY, CASAUNDRA ROCHELLE (PTA)
Entity Type:Individual
Prefix:
First Name:CASAUNDRA
Middle Name:ROCHELLE
Last Name:PERRY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CASAUNDRA
Other - Middle Name:ROCHELLE
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DELTA COLLEGE
Mailing Address - Street 2:1961 DELTA RD
Mailing Address - City:UNIVERSITY DR
Mailing Address - State:MI
Mailing Address - Zip Code:48710
Mailing Address - Country:US
Mailing Address - Phone:989-686-9316
Mailing Address - Fax:
Practice Address - Street 1:1961 DELTA RD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CENTER
Practice Address - State:MI
Practice Address - Zip Code:48710-1001
Practice Address - Country:US
Practice Address - Phone:989-686-9316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502005599225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty