Provider Demographics
NPI:1760814669
Name:PERRY, TYRAL DUSHON
Entity Type:Individual
Prefix:MR
First Name:TYRAL
Middle Name:DUSHON
Last Name:PERRY
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 1:4105 THOMAS PATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-8943
Mailing Address - Country:US
Mailing Address - Phone:973-419-3596
Mailing Address - Fax:
Practice Address - Street 1:4105 THOMAS PATRICK AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8943
Practice Address - Country:US
Practice Address - Phone:973-419-3596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner