MEDICARE: MR. FRANCISCO ORLANDO 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	10927	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10927	OTHER	FL	FL PT LICENSE

General Provider Information

NPI Number	:	1801922455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRANCISCO ORLANDO PEREZ PT

Provider Business Mailing Address
First Line	:	113 SPRINGWOOD DR
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32119-1401
Country	:	US
Telephone Number	:	386-257-7903
Fax Number	:	386-257-7903

Provider Business Practice Location Address
First Line	:	325 S SEGRAVE ST
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-4815
Country	:	US
Telephone Number	:	386-257-7903
Fax Number	:	386-257-7903

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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