Provider Demographics
NPI:1659321461
Name:SIEGEL, PERRY M (MS, AT,C CSCS)
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:M
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MS, AT,C CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR LOCKS
Mailing Address - State:CT
Mailing Address - Zip Code:06096-1439
Mailing Address - Country:US
Mailing Address - Phone:860-370-9825
Mailing Address - Fax:
Practice Address - Street 1:13 CHURCH ST
Practice Address - Street 2:
Practice Address - City:EAST GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06026-9406
Practice Address - Country:US
Practice Address - Phone:860-653-7341
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer