Healthcare Provider Details

I. General information

NPI: 1013886613
Provider Name (Legal Business Name): ONE PLACE REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5214 E STATE ROAD 64
BRADENTON FL
34208-5524
US

IV. Provider business mailing address

8039 COOPER CREEK BLVD STE 102
UNIVERSITY PARK FL
34201-3007
US

V. Phone/Fax

Practice location:
  • Phone: 941-541-4571
  • Fax: 941-212-3604
Mailing address:
  • Phone: 941-405-3557
  • Fax: 941-248-0228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KEVIN DELGADO VELASCO
Title or Position: MANAGER
Credential: PT
Phone: 347-549-3299