Provider Demographics
NPI:1104025527
Name:MARCELA PERAZA, MPT, PA
Entity Type:Organization
Organization Name:MARCELA PERAZA, MPT, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCELA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:PERAZA
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:305-987-7803
Mailing Address - Street 1:2734 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4812
Mailing Address - Country:US
Mailing Address - Phone:305-987-7803
Mailing Address - Fax:
Practice Address - Street 1:2734 JACKSON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4812
Practice Address - Country:US
Practice Address - Phone:305-987-7803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20392174400000X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891942900Medicaid