Provider Demographics
NPI:1013135714
Name:PERKINS, SALLY A (ATC)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:PERKINS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 POND ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-4413
Mailing Address - Country:US
Mailing Address - Phone:845-575-3912
Mailing Address - Fax:845-575-3282
Practice Address - Street 1:3399 NORTH RD
Practice Address - Street 2:MARIST COLLEGE
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1350
Practice Address - Country:US
Practice Address - Phone:845-575-3912
Practice Address - Fax:845-575-3282
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000871-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer