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NPI Code Detail

MEDICARE: MISS JO ANN MARIE PAETE PEREZ P.T.

MEDICARE: MISS JO ANN MARIE PAETE PEREZ P.T.
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
1225100000XPhysical Therapist
2225100000XPhysical Therapist60129528WA
3225100000XPhysical Therapist23122MD
4225100000XPhysical Therapist12420NC

General Provider Information

NPI Number : 1417283417
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JO ANN MARIE PAETE PEREZ P.T.
Provider Business Mailing Address
First Line : 2800 S 224TH ST
Second Line :
City : DES MOINES
State : WA
Zip : 98198-5132
Country : US
Telephone Number : 904-241-9231
Fax Number :
Provider Business Practice Location Address
First Line : 2800 S 224TH ST
Second Line :
City : DES MOINES
State : WA
Zip : 98198-5132
Country : US
Telephone Number : 904-241-9231
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2009
Last Update Date : 09/06/2012

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