Provider Demographics
NPI:1417283417
Name:PEREZ, JO ANN MARIE PAETE (PT)
Entity Type:Individual
Prefix:MISS
First Name:JO ANN MARIE
Middle Name:PAETE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 S 224TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-5132
Mailing Address - Country:US
Mailing Address - Phone:904-241-9231
Mailing Address - Fax:
Practice Address - Street 1:2800 S 224TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-5132
Practice Address - Country:US
Practice Address - Phone:904-241-9231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
WA60129528225100000X
MD23122225100000X
NC12420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist