Provider Demographics
NPI:1013099688
Name:PERRY, MARY LOUISE (LPTA)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:LOUISE
Last Name:PERRY
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 FIELD MOUNT RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:SC
Mailing Address - Zip Code:29061-9053
Mailing Address - Country:US
Mailing Address - Phone:803-783-9123
Mailing Address - Fax:
Practice Address - Street 1:720 RABON RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8900
Practice Address - Country:US
Practice Address - Phone:803-462-0423
Practice Address - Fax:803-462-9547
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1708174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist