Provider Demographics
NPI:1265281018
Name:PERINO, MATTHEW T (PT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:T
Last Name:PERINO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4814 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3333
Mailing Address - Country:US
Mailing Address - Phone:630-703-9962
Mailing Address - Fax:
Practice Address - Street 1:1S260 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3941
Practice Address - Country:US
Practice Address - Phone:630-703-9962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070026219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist