Provider Demographics
NPI:1871710251
Name:PERRY, PAUL DAVID (LMP)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DAVID
Last Name:PERRY
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2804 W MAPLEWOOD AVE
Mailing Address - Street 2:#101
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-8844
Mailing Address - Country:US
Mailing Address - Phone:360-303-3446
Mailing Address - Fax:
Practice Address - Street 1:511 E MAGNOLIA ST
Practice Address - Street 2:SUTIE 100
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4529
Practice Address - Country:US
Practice Address - Phone:360-752-0736
Practice Address - Fax:360-671-4656
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMA00011103225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6020529141Medicare UPIN