Provider Demographics
NPI:1982773818
Name:PERET, RICHARD TAYLOR JR (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:TAYLOR
Last Name:PERET
Suffix:JR
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 1:1211 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3341
Mailing Address - Country:US
Mailing Address - Phone:410-604-2982
Mailing Address - Fax:410-604-2985
Practice Address - Street 1:1630 MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:CHESTER
Practice Address - State:MD
Practice Address - Zip Code:21619-2791
Practice Address - Country:US
Practice Address - Phone:410-604-2982
Practice Address - Fax:410-604-2985
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5647008OtherAETNA PPO - BAOGROUP
MD8665750OtherAETNA HMO - BAOGROUP
MD1334200OtherCIGNA - BAOGROUP
MD416747300Medicaid
MD208942OtherJHHC - BAOGROUP
MD6831-0020OtherCAREFIRST - BAOGROUP
MD144122Medicare PIN
MD1334200OtherCIGNA - BAOGROUP
MD5647008OtherAETNA PPO - BAOGROUP