Provider Demographics
NPI:1306219167
Name:PEREZ, M VERONICA (PTA)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:VERONICA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 JOHN SHARP RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2540
Mailing Address - Country:US
Mailing Address - Phone:931-384-1041
Mailing Address - Fax:
Practice Address - Street 1:1669 GRANTS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-1397
Practice Address - Country:US
Practice Address - Phone:931-384-1041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3515225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant