MEDICARE: CARLOS PEREZ JR. PT, DPT

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	225100000X	Physical Therapist	1352065	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1352065	OTHER	TX	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1225705858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS PEREZ JR. PT, DPT

Provider Business Mailing Address
First Line	:	414 W SUNSET RD STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1768
Country	:	US
Telephone Number	:	210-828-7557
Fax Number	:	210-828-7756

Provider Business Practice Location Address
First Line	:	414 W SUNSET RD STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1768
Country	:	US
Telephone Number	:	210-828-7557
Fax Number	:	210-828-7756

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

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	08/27/2021

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