Provider Demographics
NPI:1568108892
Name:PEREZ, CLARISSA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 ROSE DR
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4029
Mailing Address - Country:US
Mailing Address - Phone:361-207-0467
Mailing Address - Fax:
Practice Address - Street 1:1 COYOTE TRL
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4061
Practice Address - Country:US
Practice Address - Phone:361-664-0126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT78292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer