MEDICARE: ZONIA ELVAS VELASCO PT

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	2251G0304X	Geriatric Physical Therapist	12677518	TX

General Provider Information

NPI Number	:	1417437104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZONIA ELVAS VELASCO PT

Provider Business Mailing Address
First Line	:	3553 HIGH MESA DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-7943
Country	:	US
Telephone Number	:	214-325-8121
Fax Number	:

Provider Business Practice Location Address
First Line	:	3572 FOREST LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-7932
Country	:	US
Telephone Number	:	214-325-8121
Fax Number	:

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

Provider Enumeration Date	:	08/21/2018
Last Update Date	:	08/21/2018

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Directions to “ ZONIA ELVAS VELASCO PT” Practice Location

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