Provider Demographics
NPI:1487788642
Name:PEREZ, MARK H (PT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 INTEGRA BREEZE LN STE 2C
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5512
Mailing Address - Country:US
Mailing Address - Phone:210-383-2442
Mailing Address - Fax:
Practice Address - Street 1:120 INTEGRA BREEZE LN STE 2C
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5512
Practice Address - Country:US
Practice Address - Phone:210-383-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3084225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist