MEDICARE: LANCE VELASCO PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	42183	FL

General Provider Information

NPI Number	:	1053129353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANCE VELASCO PT, DPT

Provider Business Mailing Address
First Line	:	3901 UNIVERSITY BLVD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4312
Country	:	US
Telephone Number	:	904-345-7251
Fax Number	:

Provider Business Practice Location Address
First Line	:	2616 S HWY 27
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-6526
Country	:	US
Telephone Number	:	352-565-5992
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2024
Last Update Date	:	01/06/2025

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