Provider Demographics
NPI:1518224286
Name:PERKO-WARYK, LORI (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:PERKO-WARYK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23131 EMERY RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5136
Mailing Address - Country:US
Mailing Address - Phone:216-514-9590
Mailing Address - Fax:
Practice Address - Street 1:23131 EMERY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5136
Practice Address - Country:US
Practice Address - Phone:216-514-9590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH452047828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor