Provider Demographics
NPI:1467506386
Name:PEREZ, RICARDO L (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:L
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
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Mailing Address - Street 1:4833 SARATOGA BLVD
Mailing Address - Street 2:#155
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-2213
Mailing Address - Country:US
Mailing Address - Phone:361-815-5738
Mailing Address - Fax:
Practice Address - Street 1:4833 SARATOGA BLVD
Practice Address - Street 2:#155
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-2213
Practice Address - Country:US
Practice Address - Phone:361-815-5738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX181818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82724OtherBC BS ID 82724T
TXC18852Medicare UPIN