Provider Demographics
NPI:1699045146
Name:ALBERNAL PEREZ, MADAY
Entity Type:Individual
Prefix:
First Name:MADAY
Middle Name:
Last Name:ALBERNAL PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 NE 10TH LN
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-1541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31 BARKLEY CIR
Practice Address - Street 2:SUITE 1B
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7628
Practice Address - Country:US
Practice Address - Phone:239-931-4001
Practice Address - Fax:239-931-4002
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 66472225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist