Provider Demographics
NPI:1255929279
Name:PERRY, LEVI WILLIAM (PT)
Entity type:Individual
Prefix:
First Name:LEVI
Middle Name:WILLIAM
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 1:500 N BRADDOCK ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3924
Mailing Address - Country:US
Mailing Address - Phone:540-539-4099
Mailing Address - Fax:
Practice Address - Street 1:480 W JUBAL EARLY DR STE 120
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6447
Practice Address - Country:US
Practice Address - Phone:833-493-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty