Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 41244 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | 41244 | CA |
NPI | 1205254612 |
---|---|
Provider Name | Chase Perez |
First Address | Los Gatos, CA 95032-7645 |
Second Address | Los Gatos, CA 95032-7645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2014 |
Last Update Date | 02/04/2014 |