Provider Demographics
NPI:1851753180
Name:PEREZ, TIMOTHY A (ATC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 SEAWAY CT
Mailing Address - Street 2:APT 2-108
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-1705
Mailing Address - Country:US
Mailing Address - Phone:727-772-3281
Mailing Address - Fax:
Practice Address - Street 1:3108 SEAWAY CT
Practice Address - Street 2:APT 2-108
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-1705
Practice Address - Country:US
Practice Address - Phone:727-772-3281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL4474.2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer