Provider Demographics
NPI:1255871802
Name:PERRY, MICHAEL (LMT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:PERRY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7916 N JOHN PAUL RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53563-9659
Mailing Address - Country:US
Mailing Address - Phone:608-436-8303
Mailing Address - Fax:
Practice Address - Street 1:819 E HIGH ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WI
Practice Address - Zip Code:53563-1528
Practice Address - Country:US
Practice Address - Phone:608-436-8303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3711-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist