Provider Demographics
NPI:1497764773
Name:PERELLI, KENNETH J (PT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:PERELLI
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 1:9700 N 91ST ST
Mailing Address - Street 2:SUITE A-115
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5054
Mailing Address - Country:US
Mailing Address - Phone:480-922-1376
Mailing Address - Fax:480-922-8783
Practice Address - Street 1:9700 N 91ST ST
Practice Address - Street 2:SUITE A-115
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5054
Practice Address - Country:US
Practice Address - Phone:480-922-1376
Practice Address - Fax:480-922-8783
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist