Provider Demographics
NPI:1174063291
Name:PEREZ, JAIME JAVIER SR (ATC)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:JAVIER
Last Name:PEREZ
Suffix:SR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NEW BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-5542
Mailing Address - Country:US
Mailing Address - Phone:512-665-0061
Mailing Address - Fax:512-757-8041
Practice Address - Street 1:700 NEW BRIDGE DR
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-5542
Practice Address - Country:US
Practice Address - Phone:512-665-0061
Practice Address - Fax:512-757-8041
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT23622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer