Provider Demographics
NPI:1588609341
Name:REVLETT, PERRY DEAN (MAATC,LAT)
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:DEAN
Last Name:REVLETT
Suffix:
Gender:M
Credentials:MAATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 N THORPE AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-5241
Mailing Address - Country:US
Mailing Address - Phone:386-774-4107
Mailing Address - Fax:
Practice Address - Street 1:926 HOWLAND BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-7139
Practice Address - Country:US
Practice Address - Phone:407-688-9500
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 3332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer