MEDICARE: VICTOR MANUEL PEREZ-MONTELONGO PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2173704	TX

General Provider Information

NPI Number	:	1164132890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR MANUEL PEREZ-MONTELONGO PTA

Provider Business Mailing Address
First Line	:	700 E PARK BLVD STE 100
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-8842
Country	:	US
Telephone Number	:	972-232-2227
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 E PARK BLVD STE 100
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-8842
Country	:	US
Telephone Number	:	972-232-2227
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	12/05/2022

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