Provider Demographics
NPI:1770583312
Name:PERRY, TODD C (PT)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:C
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 1:211 S BOUNDARY AVE
Mailing Address - Street 2:ESSENTIA HEALTH PROCTOR CLINIC
Mailing Address - City:PROCTOR
Mailing Address - State:MN
Mailing Address - Zip Code:55810-2306
Mailing Address - Country:US
Mailing Address - Phone:218-576-0200
Mailing Address - Fax:
Practice Address - Street 1:211 S BOUNDARY AVE
Practice Address - Street 2:ESSENTIA HEALTH PROCTOR CLINIC
Practice Address - City:PROCTOR
Practice Address - State:MN
Practice Address - Zip Code:55810-2306
Practice Address - Country:US
Practice Address - Phone:218-576-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN81572251X0800X
WI11128-242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ101418Medicare UPIN