Provider Demographics
NPI:1811657141
Name:PEREZ, RUTH MARIZ MISSION (PT)
Entity type:Individual
Prefix:
First Name:RUTH MARIZ
Middle Name:MISSION
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RUTH MARIZ
Other - Middle Name:BUNAGAN
Other - Last Name:MISSION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6828 STONEBROOK PKWY STE 300
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1303
Practice Address - Country:US
Practice Address - Phone:469-403-2022
Practice Address - Fax:972-694-7218
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TX1312646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist