Marcelus Tobias Perry, DPT
Individual provider Active NPI Physical Therapist · Ruckersville, VA
NPI 1578093845 · NPPES record last updated Jun 18, 2024
Key facts
- NPI
- 1578093845
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 2305211075 (VA)
- Practice address
- 138 Stoneridge Dr N Ste 4
Ruckersville, VA 22968-3063 - Phone
- (434) 985-2288
- NPI assigned
- Jun 19, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC, VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210527001629 | NC | Practitioner - Physical Therapist in Private Practice | 7810396603 | |
| I20220818000257 | VA | Practitioner - Physical Therapist in Private Practice | 7810396603 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ivyrehab Sept, LLC | Physical Therapist | Current |
Accepting new patients |
| At Home by Enhance Therapies LLC | Physical Therapist | Current |
Accepting new patients |
| Ivyrehab Sept, LLC | Physical Therapist | Current |
Accepting new patients |
Locations
400 Route 70
Lakewood, NJ 08701
Phone (732) 802-7512
2275 Beech Ave
Buena Vista, VA 24416
Phone (540) 466-1000
11815 Fountain Way
Ste 300
Newport News, VA 23606
Phone (757) 505-7574
138 Stoneridge Dr N
Ste 4
Ruckersville, VA 22968
Phone (434) 985-2288
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | P-CP003911T | NC | |
| Physical Therapist | 225100000X | 2305211075 | VA | Yes |
Addresses
Primary practice location
138 Stoneridge Dr N Ste 4
Ruckersville, VA 22968-3063
Mailing address
PO Box 412307
Boston, MA 02241-2307
Phone (914) 294-4050
Other practice location 1
1991 Fordham Dr Ste 102
Fayetteville, NC 28304-3774
Phone (910) 484-4653
Other providers in Ruckersville, VA
- Andy Thien Nguyen
- Frank Oliveri
- Harry Vergara Pancho
- Samantha Parker
- Heather Joanna Parrott
- Sarah E Pierce
- Jaime Nicole Pirie
- Priority Care LLC
- Quest Shuttle Service
- Rapha Medical Center LLC
All providers in Ruckersville, VA · Physical Therapist in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.