Provider Demographics
NPI:1952728404
Name:PERRY, JERELLE L SR (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:JERELLE
Middle Name:L
Last Name:PERRY
Suffix:SR
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 EUNICE LN
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-7068
Mailing Address - Country:US
Mailing Address - Phone:919-904-2714
Mailing Address - Fax:
Practice Address - Street 1:2916 EUNICE LN
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591-7068
Practice Address - Country:US
Practice Address - Phone:919-904-2714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-22
Last Update Date:2014-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11330225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist