Individual
ANDRES PERALES JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8259 WICKER AVE, SAINT JOHN, IN 46373-8878
(800) 341-1703
(877) 719-4609
Mailing address
8259 WICKER AVE, SAINT JOHN, IN 46373-8878
(800) 341-1703
(877) 719-4609
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36002820A
ATC LICENSE
IN
Enumeration date
06/27/2018
Last updated
06/27/2018
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