Provider Demographics
NPI:1013109248
Name:PERKINS, SUSAN L (LMP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:PERKINS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-3606
Mailing Address - Country:US
Mailing Address - Phone:360-461-4678
Mailing Address - Fax:
Practice Address - Street 1:719 S LAUREL ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6020
Practice Address - Country:US
Practice Address - Phone:360-461-4678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-12
Last Update Date:2007-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024012172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist