Provider Demographics
NPI:1487167722
Name:PEREZ, JOHN PAUL
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3073 SHIRLEY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-7010
Mailing Address - Country:US
Mailing Address - Phone:517-990-6211
Mailing Address - Fax:517-990-6212
Practice Address - Street 1:2040 AURELIUS RD STE 5
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-1367
Practice Address - Country:US
Practice Address - Phone:517-268-9040
Practice Address - Fax:517-990-6212
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
MI5501303259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C33679OtherBCBS