Provider Demographics
NPI:1578517892
Name:PERRY, JOHN B (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:B
Last Name:PERRY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 GREENUP AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-1953
Mailing Address - Country:US
Mailing Address - Phone:606-324-0540
Mailing Address - Fax:606-324-0616
Practice Address - Street 1:232 E HURON ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-2032
Practice Address - Country:US
Practice Address - Phone:740-286-5677
Practice Address - Fax:740-286-7661
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000217253OtherANTHEM BCBS
OH2666664OtherMOLINA MEDICAID
1578517892OtherNPI
WV3810005160Medicaid
P00359469OtherRR MEDICARE
OH4182341Medicare PIN