Provider Demographics
NPI:1134633142
Name:PERLAZA, GABRIEL ANDRES (ATC, LAT)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ANDRES
Last Name:PERLAZA
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 SAN JACINTO BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-1753
Mailing Address - Country:US
Mailing Address - Phone:512-471-8258
Mailing Address - Fax:
Practice Address - Street 1:2139 SAN JACINTO BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1753
Practice Address - Country:US
Practice Address - Phone:512-471-8258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT43482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer