Provider Demographics
NPI:1982795944
Name:PEREZ, OSVALDO (PT, DPT)
Entity Type:Individual
Prefix:
First Name:OSVALDO
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7190 SW 87TH AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2507
Mailing Address - Country:US
Mailing Address - Phone:305-662-3722
Mailing Address - Fax:305-662-9075
Practice Address - Street 1:7190 SW 87TH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2507
Practice Address - Country:US
Practice Address - Phone:305-662-3722
Practice Address - Fax:305-662-9075
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886871900Medicaid