Provider Demographics
NPI:1437932530
Name:VELASCO, IRENEO CUNETA JR
Entity Type:Individual
Prefix:
First Name:IRENEO
Middle Name:CUNETA
Last Name:VELASCO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5539 FRANKLIN AVE SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8395
Mailing Address - Country:US
Mailing Address - Phone:253-249-3659
Mailing Address - Fax:
Practice Address - Street 1:16259 SYLVESTER RD SW STE 102
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3094
Practice Address - Country:US
Practice Address - Phone:206-242-5186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant