Provider Demographics
NPI:1255675658
Name:ST. JOHN, PERRY CLIFTON (LPTA)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:CLIFTON
Last Name:ST. JOHN
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 COUNTY ROAD 483
Mailing Address - Street 2:
Mailing Address - City:HANCEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35077-8002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:440 COUNTY ROAD 483
Practice Address - Street 2:
Practice Address - City:HANCEVILLE
Practice Address - State:AL
Practice Address - Zip Code:35077
Practice Address - Country:US
Practice Address - Phone:256-507-0841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL229225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant