=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720899693
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURIE VELEZ LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2025
-----------------------------------------------------
Last Update Date | 01/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 190 S PLANK RD STE 9
-----------------------------------------------------
City | NEWBURGH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12550-3092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-565-1688
-----------------------------------------------------
Fax | 845-926-5664
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 190 S PLANK RD STE 9
-----------------------------------------------------
City | NEWBURGH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12550-3092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-565-1688
-----------------------------------------------------
Fax | 845-926-5664
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 024981
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------