Provider Demographics
NPI:1326791120
Name:PEREZ, MIGUEL ENRIQUE (DPT)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ENRIQUE
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11675 JOLLYVILLE RD STE 207
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4105
Mailing Address - Country:US
Mailing Address - Phone:512-856-1000
Mailing Address - Fax:615-373-7116
Practice Address - Street 1:11675 JOLLYVILLE RD STE 151
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4149
Practice Address - Country:US
Practice Address - Phone:512-856-1000
Practice Address - Fax:512-856-4040
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X
TX1357179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist