Provider Demographics
NPI:1407135551
Name:PEREZ, KATHLEEN MAE (PT, DPT, C/NDT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MAE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PT, DPT, C/NDT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:MAE
Other - Last Name:CATINDIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:8323 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1615
Mailing Address - Country:US
Mailing Address - Phone:713-772-1400
Mailing Address - Fax:
Practice Address - Street 1:8323 SOUTHWEST FWY
Practice Address - Street 2:SUITE 101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1615
Practice Address - Country:US
Practice Address - Phone:713-772-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1208347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3090433Medicaid