Provider Demographics
NPI:1770251282
Name:PERES, STEPHEN LOUIS (DPT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LOUIS
Last Name:PERES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N HEATHERWILDE BLVD
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3530
Mailing Address - Country:US
Mailing Address - Phone:512-324-1575
Mailing Address - Fax:
Practice Address - Street 1:200 N HEATHERWILDE BLVD
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3530
Practice Address - Country:US
Practice Address - Phone:512-324-1575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1257439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist