Provider Demographics
NPI:1659603447
Name:PEREZ, GISELLE (LMT)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 MAXIMILIAN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-6067
Mailing Address - Country:US
Mailing Address - Phone:646-229-9159
Mailing Address - Fax:
Practice Address - Street 1:3105 W WATERS AVE STE 212
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2873
Practice Address - Country:US
Practice Address - Phone:813-935-7377
Practice Address - Fax:813-932-0218
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 58184225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist