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General NPI Number Information
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NPI Number | 1134740731
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Entity Type | Individual
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Provider Name | PEDRO VELASQUEZ III PTA,CMRT,MA
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Gender | Male
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 05/05/2020
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Provider Practice Location Address
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Address Line | 18867 FM 1314 RD
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City | CONROE
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State | TX
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Zip | 77302-5925
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Country | US
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Telephone | 832-428-4962
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Fax |
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Provider Business Mailing Address
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Address Line | 18867 FM 1314 RD
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City | CONROE
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State | TX
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Zip | 77302-5925
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Country | US
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Telephone | 832-428-4962
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2052190
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License Number State | TX
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