MEDICARE: SONIA PERILES PTA

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	225200000X	Physical Therapy Assistant	2012001	TX

General Provider Information

NPI Number	:	1841423076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONIA PERILES PTA

Provider Business Mailing Address
First Line	:	5950 BRYANT IRVIN RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4210
Country	:	US
Telephone Number	:	817-294-4646
Fax Number	:

Provider Business Practice Location Address
First Line	:	5950 BRYANT IRVIN RD
Second Line	:	SUITE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4210
Country	:	US
Telephone Number	:	817-294-4646
Fax Number	:

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

Provider Enumeration Date	:	09/04/2009
Last Update Date	:	09/04/2009

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