Provider Demographics
NPI:1730458993
Name:PERRY, SHIRLEY R (PT)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:R
Last Name:PERRY
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:PO BOX 15293
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-0293
Mailing Address - Country:US
Mailing Address - Phone:415-218-3051
Mailing Address - Fax:
Practice Address - Street 1:2043 19TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1253
Practice Address - Country:US
Practice Address - Phone:415-218-3051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-17
Last Update Date:2013-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.001529225100000X
CA38872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist