Healthcare Provider Details

I. General information

NPI: 1932899978
Provider Name (Legal Business Name): ANDREW EVERETT PEREZ PT, DPT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 09/26/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27TH SPECIAL OPERATIONS MEDICAL GROUP 224 W D. L. INGRAM AVE, BLDG 1408, CANNON AFB
CLOVIS NM
88103
US

IV. Provider business mailing address

27TH SPECIAL OPERATIONS MEDICAL GROUP 224 W D. L. INGRAM AVE, BLDG 1408, CANNON AFB
CLOVIS NM
88103
US

V. Phone/Fax

Practice location:
  • Phone: 575-784-4425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT40267
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: