MEDICARE: KRISTIN NICOLE PEREZ 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	2155484	TX

General Provider Information

NPI Number	:	1508472812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN NICOLE PEREZ PTA

Provider Business Mailing Address
First Line	:	7922 FOX DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-5963
Country	:	US
Telephone Number	:	361-633-9953
Fax Number	:

Provider Business Practice Location Address
First Line	:	9929 S PADRE ISLAND DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78418-5105
Country	:	US
Telephone Number	:	361-657-0168
Fax Number	:

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

Provider Enumeration Date	:	09/22/2020
Last Update Date	:	09/22/2020

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