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General NPI Number Information
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NPI Number | 1417269846
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Entity Type | Individual
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Provider Name | JACINTA VELASQUEZ PTA
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Gender | Female
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 4022 BARDSTOWN RD STE B
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City | LOUISVILLE
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State | KY
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Zip | 40218-2649
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Country | US
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Telephone | 606-233-8270
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Fax | 502-882-1214
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Provider Business Mailing Address
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Address Line | 4022 BARDSTOWN RD STE B
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City | LOUISVILLE
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State | KY
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Zip | 40218-2649
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Country | US
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Telephone | 606-233-8270
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Fax | 502-882-1214
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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 | A02561
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License Number State | KY
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