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General NPI Number Information
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NPI Number | 1164240651
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Entity Type | Individual
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Provider Name | JONATHAN PEREZ LMT
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Gender | Male
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 21245 LORAIN RD STE 208
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City | FAIRVIEW PARK
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State | OH
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Zip | 44126-2140
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Country | US
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Telephone | 216-309-2605
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Fax |
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Provider Business Mailing Address
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Address Line | 21255 DETROIT RD APT F227
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City | ROCKY RIVER
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State | OH
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Zip | 44116-2291
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Country | US
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Telephone | 216-309-9253
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 33.026002
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License Number State | OH
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