Provider Demographics
NPI:1437396298
Name:TELLO, JONI LYNN VELASCO (RPT)
Entity Type:Individual
Prefix:MISS
First Name:JONI LYNN
Middle Name:VELASCO
Last Name:TELLO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9216 212TH PL
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1139
Mailing Address - Country:US
Mailing Address - Phone:718-740-6133
Mailing Address - Fax:
Practice Address - Street 1:9216 212TH PL
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1139
Practice Address - Country:US
Practice Address - Phone:718-740-6133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019208-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist