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General NPI Number Information
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NPI Number | 1619623832
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Entity Type | Individual
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Provider Name | ALMA VELASCO PT
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Gender | Female
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Dates
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Enumeration Date | 02/25/2022
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Last Update Date | 02/25/2022
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Provider Practice Location Address
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Address Line | 2209 SUNNINGDALE RD
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City | KINGSPORT
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State | TN
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Zip | 37660-2940
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Country | US
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Telephone | 423-292-3824
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Fax |
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Provider Business Mailing Address
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Address Line | 2209 SUNNINGDALE RD
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City | KINGSPORT
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State | TN
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Zip | 37660-2940
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Country | US
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Telephone | 423-247-3394
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT1665
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License Number State | TN
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