Provider Demographics
NPI:1417152877
Name:VELIS, RENZO E (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:RENZO
Middle Name:E
Last Name:VELIS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20601 E DIXIE HWY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1540
Mailing Address - Country:US
Mailing Address - Phone:786-923-5000
Mailing Address - Fax:786-923-5001
Practice Address - Street 1:20601 E DIXIE HWY
Practice Address - Street 2:SUITE 320
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1540
Practice Address - Country:US
Practice Address - Phone:786-923-5000
Practice Address - Fax:786-923-5001
Is Sole Proprietor?:No
Enumeration Date:2007-06-17
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 22896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22896OtherFL PT LICENSE