Provider Demographics
NPI:1205514080
Name:PEREZ, MICHELLE VANESSA (LMT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:VANESSA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 146TH ST APT 2D
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3464
Mailing Address - Country:US
Mailing Address - Phone:347-876-5342
Mailing Address - Fax:
Practice Address - Street 1:336 W 37TH ST STE 710
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-4212
Practice Address - Country:US
Practice Address - Phone:917-740-2709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033079225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist