Provider Demographics
NPI:1932063377
Name:PERALES, CORDERO
Entity type:Individual
Prefix:
First Name:CORDERO
Middle Name:
Last Name:PERALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4718 ALLEGHENY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5008
Mailing Address - Country:US
Mailing Address - Phone:956-893-2349
Mailing Address - Fax:
Practice Address - Street 1:16400 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1902
Practice Address - Country:US
Practice Address - Phone:210-724-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-10
Last Update Date:2025-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1407127225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist