Provider Demographics
NPI:1629632567
Name:PERDIKIS, ALEXANDER
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:PERDIKIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 FALMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3305
Mailing Address - Country:US
Mailing Address - Phone:508-477-5670
Mailing Address - Fax:508-539-1790
Practice Address - Street 1:684 FALMOUTH RD
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3305
Practice Address - Country:US
Practice Address - Phone:508-477-5670
Practice Address - Fax:508-539-1790
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
RIPT03195225100000X
MA26153-PT-PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist