Provider Demographics
NPI:1316174709
Name:PEREZ-GUERRA, ENRIQUE (LAT)
Entity type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:
Last Name:PEREZ-GUERRA
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W DAYTON ST
Mailing Address - Street 2:THE KOHL CENTER - BADGER SPORTS MEDICINE
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1206
Mailing Address - Country:US
Mailing Address - Phone:608-265-5698
Mailing Address - Fax:608-265-4290
Practice Address - Street 1:601 W DAYTON ST
Practice Address - Street 2:THE KOHL CENTER - BADGERS SPORTS MEDICINE
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1206
Practice Address - Country:US
Practice Address - Phone:608-265-5698
Practice Address - Fax:608-265-4290
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI129-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer