Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports |
NPI | 1437451192 |
---|---|
Provider Name | Mr. Juan Miguel Perez |
First Address | Trujillo Alto, PR 00976-6609 |
Second Address | Trujillo Alto, PR 00976-6609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2010 |
Last Update Date | 30/11/2010 |