Provider Demographics
NPI:1902812431
Name:WASSERMAN, PERRI (PT)
Entity Type:Individual
Prefix:
First Name:PERRI
Middle Name:
Last Name:WASSERMAN
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 1:965 SHAMROCK LN
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-1196
Mailing Address - Country:US
Mailing Address - Phone:814-664-4641
Mailing Address - Fax:814-644-4086
Practice Address - Street 1:965 SHAMROCK LN
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1196
Practice Address - Country:US
Practice Address - Phone:814-664-4641
Practice Address - Fax:814-644-4086
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist