Provider Demographics
NPI:1407131220
Name:PEREZ, MARIO ARTURO (PTA)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:ARTURO
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 1:700 SUNSET DR
Mailing Address - Street 2:#202
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-3127
Mailing Address - Country:US
Mailing Address - Phone:956-605-9414
Mailing Address - Fax:
Practice Address - Street 1:1301 E FERN AVE
Practice Address - Street 2:STE. D1
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-1466
Practice Address - Country:US
Practice Address - Phone:956-683-9339
Practice Address - Fax:956-683-9329
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2058876225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant