Provider Demographics
NPI:1790205995
Name:PERILLI, ANDREW (PT DPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:PERILLI
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 E DEPEW AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1815
Mailing Address - Country:US
Mailing Address - Phone:716-481-0995
Mailing Address - Fax:
Practice Address - Street 1:4901 CAMP RD STE 300
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-2625
Practice Address - Country:US
Practice Address - Phone:716-646-1100
Practice Address - Fax:716-646-1106
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041912225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist