Provider Demographics
NPI:1013127190
Name:PEREZ, LOREN HEATH (PT)
Entity Type:Individual
Prefix:MR
First Name:LOREN
Middle Name:HEATH
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1559 WESCOTT LOOP
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5615
Mailing Address - Country:US
Mailing Address - Phone:423-364-4773
Mailing Address - Fax:
Practice Address - Street 1:795 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7699
Practice Address - Country:US
Practice Address - Phone:407-340-2027
Practice Address - Fax:407-366-3254
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4942225100000X
FL31542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist