Provider Demographics
NPI:1164132890
Name:PEREZ-MONTELONGO, VICTOR MANUEL (PTA)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:MANUEL
Last Name:PEREZ-MONTELONGO
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 1:700 E PARK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8842
Mailing Address - Country:US
Mailing Address - Phone:972-232-2227
Mailing Address - Fax:
Practice Address - Street 1:700 E PARK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-8842
Practice Address - Country:US
Practice Address - Phone:972-232-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2173704225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant