Provider Demographics
NPI:1891482352
Name:PEREZ, ALISANDRA PALOMA (PTA)
Entity Type:Individual
Prefix:
First Name:ALISANDRA
Middle Name:PALOMA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15320 DAYSTAR PASS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6756
Mailing Address - Country:US
Mailing Address - Phone:956-655-3602
Mailing Address - Fax:
Practice Address - Street 1:4939 DE ZAVALA RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2001
Practice Address - Country:US
Practice Address - Phone:219-616-0629
Practice Address - Fax:210-616-0916
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2144362225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant