Provider Demographics
NPI:1861682049
Name:PEREZ, LISA VILLAVERDE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:VILLAVERDE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 CASPAR ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-5531
Mailing Address - Country:US
Mailing Address - Phone:510-589-7443
Mailing Address - Fax:
Practice Address - Street 1:4912 CASPAR ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-5531
Practice Address - Country:US
Practice Address - Phone:510-589-7443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA238492251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics