Provider Demographics
NPI:1679906929
Name:PEREZ, LOUIS VIRGILIO (PTA)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:VIRGILIO
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 SW 12 AVE
Mailing Address - Street 2:STE 1301
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136
Mailing Address - Country:US
Mailing Address - Phone:305-689-5635
Mailing Address - Fax:305-689-5930
Practice Address - Street 1:1400 NW 12 AVE
Practice Address - Street 2:STE 1301
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-689-5635
Practice Address - Fax:305-689-5930
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA22023225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant