Provider Demographics
NPI:1932899978
Name:PEREZ, ANDREW EVERETT (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:EVERETT
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
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Other - Last Name:
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Mailing Address - Street 1:27TH SPECIAL OPERATIONS MEDICAL GROUP
Mailing Address - Street 2:224 W D. L. INGRAM AVE, BLDG 1408, CANNON AFB
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27TH SPECIAL OPERATIONS MEDICAL GROUP
Practice Address - Street 2:224 W D. L. INGRAM AVE, BLDG 1408, CANNON AFB
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88103
Practice Address - Country:US
Practice Address - Phone:575-784-4425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPT402672251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic