Healthcare Provider Details

I. General information

NPI: 1639786528
Provider Name (Legal Business Name): PERLA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 E BELTLINE AVE NE
GRAND RAPIDS MI
49525-9660
US

IV. Provider business mailing address

4761 LAKE MICHIGAN DR NW STE A
GRAND RAPIDS MI
49534-6300
US

V. Phone/Fax

Practice location:
  • Phone: 616-365-2709
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501019686
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: