Provider Demographics
NPI:1720046527
Name:VELEZ, JUDE REGGIE SANTOS (PT)
Entity Type:Individual
Prefix:MR
First Name:JUDE REGGIE
Middle Name:SANTOS
Last Name:VELEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1398 VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2661
Mailing Address - Country:US
Mailing Address - Phone:770-485-2109
Mailing Address - Fax:770-485-2109
Practice Address - Street 1:1398 VICTORIA ST
Practice Address - Street 2:SUITE 160
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2661
Practice Address - Country:US
Practice Address - Phone:770-485-2109
Practice Address - Fax:770-485-2109
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist