Healthcare Provider Details

I. General information

NPI: 1508823634
Provider Name (Legal Business Name): PETER R PEREZ CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18425 PONY EXPRESS DR. R7 SUITE 107
PARKER CO
80134
US

IV. Provider business mailing address

18425 PONY EXPRESS DR. SUITE 107
PARKER CO
80134
US

V. Phone/Fax

Practice location:
  • Phone: 303-805-2282
  • Fax:
Mailing address:
  • Phone: 303-805-2282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberCMT
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: