Provider Demographics
NPI:1225402258
Name:PERKINS, IVEY JEAN (PTA)
Entity Type:Individual
Prefix:MS
First Name:IVEY
Middle Name:JEAN
Last Name:PERKINS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6109 KINGSLEY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-9730
Mailing Address - Country:US
Mailing Address - Phone:386-288-4131
Mailing Address - Fax:
Practice Address - Street 1:4796 HODGES BLVD
Practice Address - Street 2:UNIT 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224
Practice Address - Country:US
Practice Address - Phone:904-449-7246
Practice Address - Fax:904-719-7571
Is Sole Proprietor?:No
Enumeration Date:2015-11-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA25442225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant