Basic Information
Provider Information
NPI: 1003146804
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PERLADA
FirstName: HAZIEL
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1609 SUNCHASE DR
Address2:  
City: WARSAW
State: MO
PostalCode: 653553059
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 245 CAHABA VALLEY PKWY
Address2:  
City: PELHAM
State: AL
PostalCode: 351242216
CountryCode: US
TelephoneNumber: 2059426820
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/30/2009
LastUpdateDate: 12/30/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X2005036213MOY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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