Provider Demographics
NPI:1932548229
Name:PEREZ, STEPHANIE COLLEEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:COLLEEN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:WIEGAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3291 SWETZER RD
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-7607
Mailing Address - Country:US
Mailing Address - Phone:530-601-9729
Mailing Address - Fax:530-746-0657
Practice Address - Street 1:3291 SWETZER RD
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650-7607
Practice Address - Country:US
Practice Address - Phone:530-601-9729
Practice Address - Fax:530-746-0657
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist