Healthcare Provider Details

I. General information

NPI: 1033304480
Provider Name (Legal Business Name): VIRGIE LOMBOY PEREZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 ALLANS MILL DR
COLUMBIA SC
29223-4269
US

IV. Provider business mailing address

322 ALLANS MILL DR
COLUMBIA SC
29223-4269
US

V. Phone/Fax

Practice location:
  • Phone: 309-255-9207
  • Fax: 855-232-8604
Mailing address:
  • Phone: 309-255-9207
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number70015292
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7811
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: