Provider Demographics
NPI:1578538856
Name:PERRY, JEFFREY GEORGE (ATC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:GEORGE
Last Name:PERRY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10677 SPRING OAK CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2214
Mailing Address - Country:US
Mailing Address - Phone:703-426-6818
Mailing Address - Fax:703-426-2299
Practice Address - Street 1:5035 SIDEBURN RD
Practice Address - Street 2:ROBINSON HS
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-2637
Practice Address - Country:US
Practice Address - Phone:703-426-6818
Practice Address - Fax:703-426-2299
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260001662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer