Healthcare Provider Details

I. General information

NPI: 1275448136
Provider Name (Legal Business Name): EDUARDO PEREZ MS, ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36355 PEPPER RD
SELBYVILLE DE
19975-3030
US

IV. Provider business mailing address

36355 PEPPER RD
SELBYVILLE DE
19975-3030
US

V. Phone/Fax

Practice location:
  • Phone: 302-362-0450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberJ3-0010873
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: