Provider Demographics
NPI:1467032797
Name:VELEZ, KATHERINE D (PTAP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:D
Last Name:VELEZ
Suffix:
Gender:F
Credentials:PTAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 FERN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1410
Mailing Address - Country:US
Mailing Address - Phone:203-564-6021
Mailing Address - Fax:
Practice Address - Street 1:382 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1379
Practice Address - Country:US
Practice Address - Phone:203-564-6021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001622225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant