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General NPI Number Information
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NPI Number | 1659973287
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Entity Type | Individual
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Provider Name | NOEL JESUS VELAZQUEZ
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Gender | Male
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 11/09/2020
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Provider Practice Location Address
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Address Line | 3253 S HARLEM AVE STE 1B
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City | BERWYN
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State | IL
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Zip | 60402-5496
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Country | US
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Telephone | 708-788-3880
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Fax | 708-788-4757
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Provider Business Mailing Address
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Address Line | 8858 S 55TH AVE
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City | OAK LAWN
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State | IL
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Zip | 60453-1284
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Country | US
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Telephone | 708-646-8886
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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 | 070.025520
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License Number State | IL
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