Provider Demographics
NPI:1497879803
Name:PERKUNAS, JAIMIE
Entity Type:Individual
Prefix:
First Name:JAIMIE
Middle Name:
Last Name:PERKUNAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 GLENDA CT
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6626 E CALLE LA PAZ
Practice Address - Street 2:UNIT D
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4073
Practice Address - Country:US
Practice Address - Phone:815-252-2795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7427225100000X
IL70014656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist