Provider Demographics
NPI:1508823634
Name:PEREZ, PETER R (CMT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:R
Last Name:PEREZ
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18425 PONY EXPRESS DR.
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134
Mailing Address - Country:US
Mailing Address - Phone:303-805-2282
Mailing Address - Fax:
Practice Address - Street 1:18425 PONY EXPRESS DR.
Practice Address - Street 2:R7 SUITE 107
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134
Practice Address - Country:US
Practice Address - Phone:303-805-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCMT225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist