Provider Demographics
NPI:1396358347
Name:PERLUT, SUSAN M (DPT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:PERLUT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TUSCANY PARK
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3019
Mailing Address - Country:US
Mailing Address - Phone:314-488-3223
Mailing Address - Fax:
Practice Address - Street 1:10 TUSCANY PARK
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3019
Practice Address - Country:US
Practice Address - Phone:314-488-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006015477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist