Provider Demographics
NPI:1972702405
Name:PERRY, KIRSTEN (PT)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
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 1:40680 CALIFONIA OAKS RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5755
Mailing Address - Country:US
Mailing Address - Phone:951-894-4800
Mailing Address - Fax:951-894-4804
Practice Address - Street 1:5475 E LA PALMA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2075
Practice Address - Country:US
Practice Address - Phone:714-714-0479
Practice Address - Fax:714-701-7146
Is Sole Proprietor?:No
Enumeration Date:2007-07-14
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT33787AMedicare PIN
CAW17215BMedicare PIN