Provider Demographics
NPI:1356497234
Name:PERRETTA, JOSEPH (CP)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:PERRETTA
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 SW PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-1943
Mailing Address - Country:US
Mailing Address - Phone:772-871-9200
Mailing Address - Fax:772-336-4040
Practice Address - Street 1:510 SW PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-1943
Practice Address - Country:US
Practice Address - Phone:772-871-9200
Practice Address - Fax:772-336-4040
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPRO841744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0303990003Medicare NSC