Provider Demographics
NPI:1700576311
Name:PEREZ, MICHELLE IRIS (NCLMBT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:IRIS
Last Name:PEREZ
Suffix:
Gender:F
Credentials:NCLMBT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:I
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NCLMBT
Mailing Address - Street 1:117 HUNT CLUB LN APT C
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-7640
Mailing Address - Country:US
Mailing Address - Phone:919-803-9968
Mailing Address - Fax:
Practice Address - Street 1:117 HUNT CLUB LN APT C
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-7640
Practice Address - Country:US
Practice Address - Phone:919-803-9968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20245225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty