Provider Demographics
NPI:1104432350
Name:PEREZ, CORINA ANNE (LMT)
Entity type:Individual
Prefix:MRS
First Name:CORINA
Middle Name:ANNE
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 1:16856 YAWL CT
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-5016
Mailing Address - Country:US
Mailing Address - Phone:130-254-2064
Mailing Address - Fax:
Practice Address - Street 1:1520 SAVANNAH RD STE 2
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1624
Practice Address - Country:US
Practice Address - Phone:302-542-0645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEMT0001028225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty