Provider Demographics
NPI:1518145242
Name:PEREZ, MARCIA M (PT)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:M
Other - Last Name:GRANIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:113 KENSINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8042
Mailing Address - Country:US
Mailing Address - Phone:914-213-5481
Mailing Address - Fax:
Practice Address - Street 1:772 BRAWLEY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9122
Practice Address - Country:US
Practice Address - Phone:914-213-5481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19905225100000X
NY027881225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist