Provider Demographics
NPI:1497868103
Name:PERRY, DANIEL ROBERT (MPT, DIP, MDT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROBERT
Last Name:PERRY
Suffix:
Gender:M
Credentials:MPT, DIP, MDT
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 797
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:VA
Mailing Address - Zip Code:24348-0797
Mailing Address - Country:US
Mailing Address - Phone:276-773-8145
Mailing Address - Fax:276-773-3912
Practice Address - Street 1:304 DAVIS ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:VA
Practice Address - Zip Code:24348
Practice Address - Country:US
Practice Address - Phone:276-773-8145
Practice Address - Fax:276-773-3912
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052031142251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC6610OtherMEDCOST
VA194022OtherSOUTHERN HEALTH SERVICES
VA194024OtherSOUTHERN HEALTH SERVICES
VA462552OtherANTHEM BLUE CROSS
VA194025OtherSOUTHERN HEALTH SERVICES
WV1064679OtherWEST VA WORKERS COMPENSAT
VA190423OtherSOUTHERN HEALTH SERVICES
VA194024OtherSOUTHERN HEALTH SERVICES
WV1064679OtherWEST VA WORKERS COMPENSAT