Provider Demographics
NPI:1619623832
Name:VELASCO, ALMA (PT)
Entity Type:Individual
Prefix:MRS
First Name:ALMA
Middle Name:
Last Name:VELASCO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 SUNNINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-2940
Mailing Address - Country:US
Mailing Address - Phone:423-247-3394
Mailing Address - Fax:
Practice Address - Street 1:2209 SUNNINGDALE RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-2940
Practice Address - Country:US
Practice Address - Phone:423-292-3824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT1665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist