Provider Demographics
NPI:1942313564
Name:PEREZ, VIOLA (PT)
Entity Type:Individual
Prefix:MS
First Name:VIOLA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3054 S MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-5231
Mailing Address - Country:US
Mailing Address - Phone:918-712-7021
Mailing Address - Fax:918-712-9326
Practice Address - Street 1:5930 E 31ST ST
Practice Address - Street 2:SUITE 500
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5107
Practice Address - Country:US
Practice Address - Phone:918-712-7021
Practice Address - Fax:918-712-9326
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100668060 CMedicaid
OK100634320 AMedicaid
OK100634320 BMedicaid