Provider Demographics
NPI:1760713358
Name:PEREZ, JAZZELINE NICOLE
Entity Type:Individual
Prefix:
First Name:JAZZELINE
Middle Name:NICOLE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 MAIN ST
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4946
Mailing Address - Country:US
Mailing Address - Phone:203-378-0092
Mailing Address - Fax:203-375-4540
Practice Address - Street 1:728 POST RD E
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5200
Practice Address - Country:US
Practice Address - Phone:203-341-0488
Practice Address - Fax:203-227-8809
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist