Provider Demographics
NPI:1093110405
Name:PEREZ, OSVALDO (PTA)
Entity Type:Individual
Prefix:
First Name:OSVALDO
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12060 SW 129TH CT
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4581
Mailing Address - Country:US
Mailing Address - Phone:305-378-5247
Mailing Address - Fax:305-378-6760
Practice Address - Street 1:12060 SW 129TH CT
Practice Address - Street 2:SUITE 107
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4581
Practice Address - Country:US
Practice Address - Phone:305-378-5247
Practice Address - Fax:305-378-6760
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA18252225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA18252OtherDEPT OF HEALTH