Provider Demographics
NPI:1497878615
Name:PERRY, CIARA LATRICE (ATC)
Entity Type:Individual
Prefix:MS
First Name:CIARA
Middle Name:LATRICE
Last Name:PERRY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12149 S EGGLESTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-6305
Mailing Address - Country:US
Mailing Address - Phone:773-995-6958
Mailing Address - Fax:
Practice Address - Street 1:12149 S EGGLESTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-6305
Practice Address - Country:US
Practice Address - Phone:773-995-6958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer