Provider Demographics
NPI:1417906116
Name:PERRY, SAUNDRA J (PT)
Entity type:Individual
Prefix:
First Name:SAUNDRA
Middle Name:J
Last Name:PERRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57190 MAIN RD
Mailing Address - Street 2:POBOX 1824
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-4750
Mailing Address - Country:US
Mailing Address - Phone:631-765-3620
Mailing Address - Fax:631-765-0013
Practice Address - Street 1:57190 MAIN RD
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-4750
Practice Address - Country:US
Practice Address - Phone:631-765-3620
Practice Address - Fax:631-765-0013
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06894225100000X, 2251C2600X, 2251G0304X, 2251N0400X, 2251P0200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA2527929OtherORTHONET
NYAZ00670OtherMDNY
NYAZ00670OtherMDNY