Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 21936 | FL |
N | 2251S0007X | Physical Therapist - Sports | PT 21936 | FL |
N | 2251X0800X | Physical Therapist - Orthopedic | PT 21936 | FL |
NPI | 1457682981 |
---|---|
Provider Name | Carlos Alberto Velazco |
First Address | Miami, FL 33176-2302 |
Second Address | Miami, FL 33176-2302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2010 |
Last Update Date | 22/01/2010 |