Provider Demographics
NPI:1932318862
Name:PERRY, EDWIN RUFINO (MSPT)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:RUFINO
Last Name:PERRY
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 NEW LONDON TPKE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-6513
Mailing Address - Country:US
Mailing Address - Phone:860-961-4419
Mailing Address - Fax:
Practice Address - Street 1:171 ROPE FERRY RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2600
Practice Address - Country:US
Practice Address - Phone:860-443-8357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist