Provider Demographics
NPI:1396721627
Name:PERLIS, RAQUEL K (PT)
Entity type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:K
Last Name:PERLIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:332 WASHINGTON ST
Mailing Address - Street 2:SUITE 315
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6219
Mailing Address - Country:US
Mailing Address - Phone:781-237-9006
Mailing Address - Fax:781-237-4723
Practice Address - Street 1:332 WASHINGTON ST
Practice Address - Street 2:SUITE 315
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-6219
Practice Address - Country:US
Practice Address - Phone:781-237-9006
Practice Address - Fax:781-237-4723
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA5853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPT005001Medicare PIN