Provider Demographics
NPI:1710576814
Name:PEREZ RENTERIA, SOFIA (PT)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:PEREZ RENTERIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S MILLBEND DR APT 2101
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1857
Mailing Address - Country:US
Mailing Address - Phone:210-748-1397
Mailing Address - Fax:
Practice Address - Street 1:5600 CYPRESSWOOD DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-8691
Practice Address - Country:US
Practice Address - Phone:281-767-2715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1264682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist