Provider Demographics
NPI:1407287881
Name:PEREZ, DANIELLE (LMP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6815 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-0571
Mailing Address - Country:US
Mailing Address - Phone:509-990-4554
Mailing Address - Fax:
Practice Address - Street 1:613 S WASHINGTON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2535
Practice Address - Country:US
Practice Address - Phone:509-990-4554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60418238225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist