MEDICARE: KRISTEN MARIE PEREZ PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1335688	TX

General Provider Information

NPI Number	:	1144836875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN MARIE PEREZ PT

Provider Business Mailing Address
First Line	:	5040 ADDISON CIR STE 400
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-6049
Country	:	US
Telephone Number	:	214-983-0303
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 W SLAUGHTER LN STE 300
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-1774
Country	:	US
Telephone Number	:	512-277-6643
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	09/18/2020

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