Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT116755 | TX |
NPI | 1003487554 |
---|---|
Provider Name | Jeffrey Alan Perez |
First Address | Pasadena, TX 77505-3233 |
Second Address | Pasadena, TX 77505-3233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2021 |
Last Update Date | 06/07/2021 |