Provider Demographics
NPI:1457319501
Name:PERRY, ANNA C (PT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:C
Last Name:PERRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:C
Other - Last Name:WILHELM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:850 43RD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8401
Mailing Address - Country:US
Mailing Address - Phone:309-743-2070
Mailing Address - Fax:309-743-2073
Practice Address - Street 1:900 14TH ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742-1004
Practice Address - Country:US
Practice Address - Phone:563-659-1759
Practice Address - Fax:563-659-3237
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA03891OtherPT LICENSE NUMBER
IA03891OtherPT LICENSE NUMBER