Provider Demographics
NPI:1063788438
Name:PEREZ, ELENA KIM (RN,PT)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:KIM
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RN,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DUDLEY ST STE 530
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3230
Mailing Address - Country:US
Mailing Address - Phone:401-444-4787
Mailing Address - Fax:401-444-2838
Practice Address - Street 1:2 DUDLEY ST STE 530
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3230
Practice Address - Country:US
Practice Address - Phone:401-444-4787
Practice Address - Fax:401-444-2838
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT022582251N0400X
RIRN43432163WN0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience