Individual
BRENDA PEREZ
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
216 6TH ST, ST AUGUSTINE, FL 32080-7909
(386) 312-0022
(386) 312-0535
Mailing address
216 6TH ST, ST AUGUSTINE, FL 32080-7909
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA10087
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA10087
LICENSE NUMBER
FL
Enumeration date
11/11/2005
Last updated
07/08/2007
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