Healthcare Provider Details

I. General information

NPI: 1417437104
Provider Name (Legal Business Name): ZONIA ELVAS VELASCO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3572 FOREST LN
DALLAS TX
75234-7932
US

IV. Provider business mailing address

3553 HIGH MESA DR
DALLAS TX
75234-7943
US

V. Phone/Fax

Practice location:
  • Phone: 214-325-8121
  • Fax:
Mailing address:
  • Phone: 214-325-8121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number12677518
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: