Provider Demographics
NPI:1184083354
Name:PEREZ, AL (PT)
Entity type:Individual
Prefix:
First Name:AL
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:AL
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:11233 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-3840
Mailing Address - Country:US
Mailing Address - Phone:818-590-3526
Mailing Address - Fax:
Practice Address - Street 1:11233 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-3840
Practice Address - Country:US
Practice Address - Phone:818-590-3526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist