Provider Demographics
NPI:1811459092
Name:PEREZ, CHRISTOPHER (LAT, ATC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 NE 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5672
Mailing Address - Country:US
Mailing Address - Phone:786-303-4046
Mailing Address - Fax:
Practice Address - Street 1:1775 NE 37TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-5672
Practice Address - Country:US
Practice Address - Phone:786-303-4046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL55082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer