Provider Demographics
NPI:1558561407
Name:VELEZ, LUIS GUILLERMO (MA, ATC, LAT, CSCS)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:GUILLERMO
Last Name:VELEZ
Suffix:
Gender:M
Credentials:MA, ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 7TH AVE NE
Mailing Address - Street 2:MCCRORIE 100B
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3984
Mailing Address - Country:US
Mailing Address - Phone:828-328-7124
Mailing Address - Fax:
Practice Address - Street 1:625 7TH AVE NE
Practice Address - Street 2:MCCRORIE 100B
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3984
Practice Address - Country:US
Practice Address - Phone:828-328-7124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer