Provider Demographics
NPI:1205012853
Name:ZERVES, PERRY P
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:P
Last Name:ZERVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 AMBER SANDS DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426
Mailing Address - Country:US
Mailing Address - Phone:928-788-7014
Mailing Address - Fax:
Practice Address - Street 1:5151 S AMBER SANDS DR
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-6537
Practice Address - Country:US
Practice Address - Phone:928-788-7014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4094235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist