Provider Demographics
NPI:1609991728
Name:VELEZ VEGA, MARISOL (RPT)
Entity Type:Individual
Prefix:MISS
First Name:MARISOL
Middle Name:
Last Name:VELEZ VEGA
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 1:151 RUTA 474
Mailing Address - Street 2:GALATEO BAJO
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0010
Mailing Address - Country:US
Mailing Address - Phone:787-872-1717
Mailing Address - Fax:787-830-6804
Practice Address - Street 1:151 RUTA 474
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-830-1227
Practice Address - Fax:787-830-1227
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist