Provider Demographics
NPI:1508960618
Name:PEREZ PEREZ, MARISOL (PT DPT)
Entity Type:Individual
Prefix:MRS
First Name:MARISOL
Middle Name:
Last Name:PEREZ PEREZ
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602
Mailing Address - Country:US
Mailing Address - Phone:787-830-7714
Mailing Address - Fax:787-830-7714
Practice Address - Street 1:42 AVE. JUAN HERNANDEZ
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-830-7714
Practice Address - Fax:787-830-7714
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3302962OtherACAA
6620098OtherHUMANA
6892928OtherCIGNA
223193OtherPREFERRED HEALTH
500014OtherPREFERRED MEDICARE CHOICE
28725OtherPROSSAM
7480OtherINTERNATIONAL
870045OtherMMM
870045OtherMMM