Healthcare Provider Details

I. General information

NPI: 1205254612
Provider Name (Legal Business Name): CHASE PEREZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16615 LARK AVE
LOS GATOS CA
95032-7645
US

IV. Provider business mailing address

16615 LARK AVE
LOS GATOS CA
95032-7645
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-1460
  • Fax: 408-358-1459
Mailing address:
  • Phone: 408-358-1460
  • Fax: 408-358-1459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number41244
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number41244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: