Provider Demographics
NPI:1881992576
Name:PEREZ, MELISSA EMMA
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:EMMA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:EMMA
Other - Last Name:PEREZ-HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4901 LOWELL RD
Mailing Address - Street 2:4901 LOWELL RD
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-4325
Mailing Address - Country:US
Mailing Address - Phone:813-215-1815
Mailing Address - Fax:
Practice Address - Street 1:2901 W. BUSH BLVD.
Practice Address - Street 2:SUIT 916
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614
Practice Address - Country:US
Practice Address - Phone:813-478-1711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist