Provider Demographics
NPI:1740226679
Name:SAUNDRA J PERRY RPT PC
Entity Type:Organization
Organization Name:SAUNDRA J PERRY RPT PC
Other - Org Name:SAUNDRA PERRY PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SAUNDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-765-3620
Mailing Address - Street 1:57190 MAIN RD
Mailing Address - Street 2:PO BOX 1824
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-4750
Mailing Address - Country:US
Mailing Address - Phone:631-765-3620
Mailing Address - Fax:631-765-0013
Practice Address - Street 1:57190 MAIN RD
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-4750
Practice Address - Country:US
Practice Address - Phone:631-765-3620
Practice Address - Fax:631-765-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA2527929OtherORTHONET
NYA2527929OtherORTHONET
NYA2527929OtherORTHONET