Provider Demographics
NPI:1720066756
Name:PEREZ, RICHARD PAUL (RPT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:PAUL
Last Name:PEREZ
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 LAWRENCE ST
Mailing Address - Street 2:STE 101
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-6559
Mailing Address - Country:US
Mailing Address - Phone:360-385-1035
Mailing Address - Fax:360-385-4395
Practice Address - Street 1:1215 LAWRENCE ST
Practice Address - Street 2:STE 204
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6559
Practice Address - Country:US
Practice Address - Phone:360-385-1035
Practice Address - Fax:360-385-4395
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60132077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60132077OtherPHYSICAL THERAPY LICENSE
WAZZZ2533ZOtherBLUE CROSS ID
WA60132077OtherPHYSICAL THERAPY LICENSE
WAZZZ2533ZOtherBLUE CROSS ID