Healthcare Provider Details

I. General information

NPI: 1366272486
Provider Name (Legal Business Name): ONE PLACE PERFORMANCE AND OSTEOPRACTIC PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

17532 CANTARINA CV
BRADENTON FL
34211-1151
US

V. Phone/Fax

Practice location:
  • Phone: 347-549-3299
  • Fax:
Mailing address:
  • Phone: 347-549-3299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

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