Provider Demographics
NPI:1407040249
Name:PERKINS, MICHELE RENEE (PT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:RENEE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W TEMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2168
Mailing Address - Country:US
Mailing Address - Phone:217-342-5800
Mailing Address - Fax:217-347-3311
Practice Address - Street 1:801 W TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2168
Practice Address - Country:US
Practice Address - Phone:217-342-5800
Practice Address - Fax:217-347-3311
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist