Provider Demographics
NPI:1275264822
Name:PERRY, MADISON ROSE (BS)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:ROSE
Last Name:PERRY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3701
Mailing Address - Country:US
Mailing Address - Phone:603-357-4400
Mailing Address - Fax:603-357-9648
Practice Address - Street 1:9 CHURCH ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3885
Practice Address - Country:US
Practice Address - Phone:603-357-4400
Practice Address - Fax:603-357-9648
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach