Provider Demographics
NPI:1720745789
Name:GOMEZ, HERMES BEN (LMT)
Entity Type:Individual
Prefix:
First Name:HERMES
Middle Name:BEN
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 INDIGO RD
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-5727
Mailing Address - Country:US
Mailing Address - Phone:843-367-0608
Mailing Address - Fax:
Practice Address - Street 1:428 INDIGO RD
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5727
Practice Address - Country:US
Practice Address - Phone:843-367-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8252225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist