Provider Demographics
NPI:1447277975
Name:PERRY, ROBERT F (PT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:F
Last Name:PERRY
Suffix:
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 1:1266 PINE VALLEY DR
Mailing Address - Street 2:STE. 203
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-6614
Mailing Address - Country:US
Mailing Address - Phone:312-961-6837
Mailing Address - Fax:866-208-9129
Practice Address - Street 1:1266 PINE VALLEY DR
Practice Address - Street 2:STE. 203
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-6614
Practice Address - Country:US
Practice Address - Phone:312-961-6837
Practice Address - Fax:866-208-9129
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILS96943Medicare UPIN
IL21008Medicare ID - Type Unspecified