Provider Demographics
NPI:1033304480
Name:PEREZ, VIRGIE LOMBOY (PT)
Entity Type:Individual
Prefix:
First Name:VIRGIE
Middle Name:LOMBOY
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 ALLANS MILL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4269
Mailing Address - Country:US
Mailing Address - Phone:309-255-9207
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:322 ALLANS MILL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4269
Practice Address - Country:US
Practice Address - Phone:309-255-9207
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70015292225100000X
SC7811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist