Healthcare Provider Details

I. General information

NPI: 1144185356
Provider Name (Legal Business Name): SCOTT VELASCO LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 NIMMO PKWY STE 110
VIRGINIA BEACH VA
23456-7782
US

IV. Provider business mailing address

1253 NIMMO PKWY STE 110
VIRGINIA BEACH VA
23456-7782
US

V. Phone/Fax

Practice location:
  • Phone: 757-918-7761
  • Fax: 757-918-7761
Mailing address:
  • Phone: 757-918-7761
  • Fax: 757-918-7761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019020417
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: