Provider Demographics
NPI:1275164378
Name:CANTU, ADRIAN PEREZ (PT, DPT, MED)
Entity Type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:PEREZ
Last Name:CANTU
Suffix:
Gender:M
Credentials:PT, DPT, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4952 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-1742
Mailing Address - Country:US
Mailing Address - Phone:361-549-9382
Mailing Address - Fax:
Practice Address - Street 1:3300 SW WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:JOSHUA
Practice Address - State:TX
Practice Address - Zip Code:76058-6164
Practice Address - Country:US
Practice Address - Phone:682-207-8468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1307147261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy