Provider Demographics
NPI:1700946837
Name:PEREZ, PATRICIA G (PTA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:G
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 1:2511 REDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-4497
Mailing Address - Country:US
Mailing Address - Phone:845-551-3111
Mailing Address - Fax:
Practice Address - Street 1:2511 REDSTONE DR
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-4497
Practice Address - Country:US
Practice Address - Phone:845-551-3111
Practice Address - Fax:845-294-8650
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2065670102X00000X
NY005771-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2065670Medicaid
TX2065670OtherPHYSICAL THERAPIST ASSISTANT