Provider Demographics
NPI:1336497684
Name:PERDUE, NORMA (PTA)
Entity Type:Individual
Prefix:MS
First Name:NORMA
Middle Name:
Last Name:PERDUE
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 1:910 SIMPSON AVE # 130
Mailing Address - Street 2:
Mailing Address - City:HOQUIAM
Mailing Address - State:WA
Mailing Address - Zip Code:98550-3815
Mailing Address - Country:US
Mailing Address - Phone:360-349-7634
Mailing Address - Fax:
Practice Address - Street 1:910 SIMPSON AVE # 130
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-3815
Practice Address - Country:US
Practice Address - Phone:360-349-7634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60242039225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant