Provider Demographics
NPI:1013115559
Name:PERRY, JANET GAYLE (MPT)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:GAYLE
Last Name:PERRY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:JANET
Other - Middle Name:GAYLE
Other - Last Name:GAINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4021 SW SEYMOUR CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-3614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:540 S MAIN ST
Practice Address - Street 2:PROVIDENCE BENEDICTINE REHAB DPT
Practice Address - City:MOUNT ANGEL
Practice Address - State:OR
Practice Address - Zip Code:97362-9540
Practice Address - Country:US
Practice Address - Phone:503-845-2736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist