Healthcare Provider Details

I. General information

NPI: 1225705858
Provider Name (Legal Business Name): CARLOS PEREZ JR. PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 W SUNSET RD STE 101
SAN ANTONIO TX
78209-1768
US

IV. Provider business mailing address

414 W SUNSET RD STE 101
SAN ANTONIO TX
78209-1768
US

V. Phone/Fax

Practice location:
  • Phone: 210-828-7557
  • Fax: 210-828-7756
Mailing address:
  • Phone: 210-828-7557
  • Fax: 210-828-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1352065
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: