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General NPI Number Information
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NPI Number | 1407525975
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Entity Type | Individual
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Provider Name | SHANNON PERUYERO PTA
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Gender | Female
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Dates
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Enumeration Date | 09/08/2021
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 1085 W 64TH ST
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City | HIALEAH
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State | FL
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Zip | 33012-6416
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Country | US
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Telephone | 754-307-7024
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Fax |
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Provider Business Mailing Address
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Address Line | 50 NE 26TH AVE STE 311
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City | POMPANO BEACH
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State | FL
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Zip | 33062-5245
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Country | US
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Telephone | 754-307-7024
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA31464
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License Number State | FL
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