Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA4985 | FL |
NPI | 1013069863 |
---|---|
Provider Name | Mr. Richard Anthony Velez |
First Address | Clearwater, FL 33755-4908 |
Second Address | Clearwater, FL 33755-4908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 08/07/2007 |