Provider Demographics
NPI:1043932908
Name:VELOTAS, ANNIE (PT)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:VELOTAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 WESLEYAN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3103
Mailing Address - Country:US
Mailing Address - Phone:800-603-6046
Mailing Address - Fax:
Practice Address - Street 1:200 ONE NINETEEN BLVD
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35242-7236
Practice Address - Country:US
Practice Address - Phone:205-745-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty