Provider Demographics
NPI:1366710246
Name:PEREZ, SANDRA (LMT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
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 1:9600 SW 8TH ST
Mailing Address - Street 2:SUITE 35
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2900
Mailing Address - Country:US
Mailing Address - Phone:305-226-4192
Mailing Address - Fax:305-226-4193
Practice Address - Street 1:9600 SW 8TH ST
Practice Address - Street 2:SUITE 35
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2900
Practice Address - Country:US
Practice Address - Phone:305-226-4192
Practice Address - Fax:305-226-4193
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA64829225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist