Healthcare Provider Details

I. General information

NPI: 1093472904
Provider Name (Legal Business Name): MICHAEL VELASQUEZ PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2021
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 FARMINGTON AVE
FARMINGTON CT
06032-1936
US

IV. Provider business mailing address

88 ELMWOOD DR
CHESHIRE CT
06410-4256
US

V. Phone/Fax

Practice location:
  • Phone: 860-837-6300
  • Fax:
Mailing address:
  • Phone: 860-798-7963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14.012458
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: