Provider Demographics
NPI:1609937887
Name:PERDUE, RAQUEL A (PT)
Entity Type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:A
Last Name:PERDUE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15412 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-3056
Mailing Address - Country:US
Mailing Address - Phone:602-795-3277
Mailing Address - Fax:602-795-3359
Practice Address - Street 1:15412 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-3056
Practice Address - Country:US
Practice Address - Phone:602-795-3277
Practice Address - Fax:602-795-3359
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist