Provider Demographics
NPI:1477544906
Name:PERRAS, ROBERT L (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:PERRAS
Suffix:
Gender:M
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:PO BOX 1837
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98328-1837
Mailing Address - Country:US
Mailing Address - Phone:360-832-8890
Mailing Address - Fax:360-832-8893
Practice Address - Street 1:313 CENTER ST E
Practice Address - Street 2:SUITE 5
Practice Address - City:EATONVILLE
Practice Address - State:WA
Practice Address - Zip Code:98328-7449
Practice Address - Country:US
Practice Address - Phone:360-832-8890
Practice Address - Fax:360-832-8893
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8334849Medicaid
WA8334849Medicaid