Provider Demographics
NPI:1275001844
Name:PERKINS, JONATHAN G (PTA)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:G
Last Name:PERKINS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 RITCHIE RD
Mailing Address - Street 2:
Mailing Address - City:LORENA
Mailing Address - State:TX
Mailing Address - Zip Code:76655-3212
Mailing Address - Country:US
Mailing Address - Phone:254-301-8969
Mailing Address - Fax:
Practice Address - Street 1:1632 RITCHIE RD
Practice Address - Street 2:
Practice Address - City:LORENA
Practice Address - State:TX
Practice Address - Zip Code:76655-3212
Practice Address - Country:US
Practice Address - Phone:254-301-8969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2103717208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation