Provider Demographics
NPI:1033482658
Name:VELARDE, ABBI KRISTLE
Entity Type:Individual
Prefix:
First Name:ABBI KRISTLE
Middle Name:
Last Name:VELARDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 E 12TH ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1088
Mailing Address - Country:US
Mailing Address - Phone:718-676-9866
Mailing Address - Fax:718-998-9059
Practice Address - Street 1:1729 E 12TH ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1088
Practice Address - Country:US
Practice Address - Phone:718-676-9866
Practice Address - Fax:718-998-9059
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist