Provider Demographics
NPI:1598402224
Name:VELASQUEZ, MIKELA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MIKELA
Middle Name:
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11163 LAUGHLIN LN
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3666
Mailing Address - Country:US
Mailing Address - Phone:323-317-3729
Mailing Address - Fax:
Practice Address - Street 1:18757 BURBANK BLVD STE 118
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6345
Practice Address - Country:US
Practice Address - Phone:818-812-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-14
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302052225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist