Provider Demographics
NPI:1770567091
Name:PERRY, MATTHEW (DPT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:PERRY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2088 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1709
Mailing Address - Country:US
Mailing Address - Phone:516-222-2455
Mailing Address - Fax:516-222-2459
Practice Address - Street 1:2088 FRONT ST
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1709
Practice Address - Country:US
Practice Address - Phone:516-222-2455
Practice Address - Fax:516-222-2459
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025872-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161719136OtherPROVIDER
NY6697166OtherPROVIDER
NY6697166OtherPROVIDER