Healthcare Provider Details

I. General information

NPI: 1053814665
Provider Name (Legal Business Name): RAMON MARIN VELASQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2018
Last Update Date: 03/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

7836 ASHBROOK DR
HASLETT MI
48840-8854
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-2786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: