Basic Information
| Provider Information | |||||||||
| NPI: | 1720580418 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERAINO-MARTINEZ | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | ELLEN | ||||||||
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| Credential: | PTA | ||||||||
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| OtherLastName: | PERAINO | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
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| OtherCredential: | PTA | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 18714 N FM 493 | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785425259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563938334 | ||||||||
| FaxNumber: | 9566304447 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 S JACKSON RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785031589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566304400 | ||||||||
| FaxNumber: | 9566304447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2018 | ||||||||
| LastUpdateDate: | 03/08/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2078855 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.