Provider Demographics
NPI:1639544836
Name:PERKINS, JUSTIN (ATC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:PERKINS
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 1:1325 TRADE SQ W APT 4
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1278
Mailing Address - Country:US
Mailing Address - Phone:419-769-5679
Mailing Address - Fax:
Practice Address - Street 1:450 N HYATT ST
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-1433
Practice Address - Country:US
Practice Address - Phone:937-440-7152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0039562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer