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General NPI Number Information
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NPI Number | 1841663697
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Entity Type | Individual
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Provider Name | MARY RUTH VELICKI PT, MSPT, DPT
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Gender | Female
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Dates
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Enumeration Date | 11/02/2015
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 20321 SW ACACIA ST STE 150
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-1763
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Country | US
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Telephone | 949-851-8121
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Fax | 949-851-9537
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Provider Business Mailing Address
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Address Line | 20321 SW ACACIA ST STE 150
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-1763
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Country | US
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Telephone | 949-851-8121
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Fax | 949-851-9537
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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 | 12330
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License Number State | CA
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