Provider Demographics
NPI:1124226790
Name:VELAZQUEZ, MARYURI H (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MARYURI
Middle Name:H
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 N STATE ROAD 7
Mailing Address - Street 2:SUITE 112
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3201
Mailing Address - Country:US
Mailing Address - Phone:954-562-6197
Mailing Address - Fax:
Practice Address - Street 1:2525 N STATE ROAD 7
Practice Address - Street 2:SUITE 112
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3201
Practice Address - Country:US
Practice Address - Phone:954-562-6197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA34576225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist