Provider Demographics
NPI:1689948267
Name:PEREZ, GRISELDA M (LMT)
Entity Type:Individual
Prefix:MRS
First Name:GRISELDA
Middle Name:M
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 1:301 W GRIFFIN PKWY STE 10
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2221
Mailing Address - Country:US
Mailing Address - Phone:956-802-4014
Mailing Address - Fax:
Practice Address - Street 1:1820 E GRIFFIN PKWY STE F
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3109
Practice Address - Country:US
Practice Address - Phone:956-802-4014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT110654225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist