Provider Demographics
NPI:1982937520
Name:PEREZ, MICHELLE A (LMT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
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 1:200 SAINT ANDREWS BLVD APT 2105
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4245
Mailing Address - Country:US
Mailing Address - Phone:407-222-3210
Mailing Address - Fax:
Practice Address - Street 1:1111 S LAKEMONT AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5496
Practice Address - Country:US
Practice Address - Phone:407-222-3210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 12260174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist