Healthcare Provider Details

I. General information

NPI: 1457682981
Provider Name (Legal Business Name): CARLOS ALBERTO VELAZCO P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9135 SW 87TH AVE
MIAMI FL
33176-2302
US

IV. Provider business mailing address

9135 SW 87TH AVE
MIAMI FL
33176-2302
US

V. Phone/Fax

Practice location:
  • Phone: 305-274-3311
  • Fax: 305-274-1411
Mailing address:
  • Phone: 305-274-3311
  • Fax: 305-274-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 21936
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT 21936
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT 21936
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: