Provider Demographics
NPI:1053702977
Name:PEREZ-GUERRA, JILL ANN (MS LAT)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANN
Last Name:PEREZ-GUERRA
Suffix:
Gender:F
Credentials:MS LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 IRIS BLOOM CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-4088
Mailing Address - Country:US
Mailing Address - Phone:608-235-7535
Mailing Address - Fax:
Practice Address - Street 1:1 IRIS BLOOM CIR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-4088
Practice Address - Country:US
Practice Address - Phone:608-235-7535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer