Provider Demographics
NPI:1437361409
Name:PERCIC, RICHARD (ATC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:PERCIC
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 W LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-1107
Mailing Address - Country:US
Mailing Address - Phone:330-424-5482
Mailing Address - Fax:
Practice Address - Street 1:1020 TRUMP RD NW
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-8422
Practice Address - Country:US
Practice Address - Phone:330-627-6801
Practice Address - Fax:330-627-6803
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-0007972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer