Provider Demographics
NPI:1720580418
Name:PERAINO-MARTINEZ, JENNIFER ELLEN (PTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELLEN
Last Name:PERAINO-MARTINEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:PERAINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:18714 N FM 493
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-5259
Mailing Address - Country:US
Mailing Address - Phone:956-393-8334
Mailing Address - Fax:956-630-4447
Practice Address - Street 1:1900 S JACKSON RD STE 2
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1589
Practice Address - Country:US
Practice Address - Phone:956-630-4400
Practice Address - Fax:956-630-4447
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2078855225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant