Provider Demographics
NPI:1790138386
Name:VELLER, TATIANA
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:VELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 AVENUE W
Mailing Address - Street 2:APT. 5R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5551
Mailing Address - Country:US
Mailing Address - Phone:718-551-8125
Mailing Address - Fax:718-551-8125
Practice Address - Street 1:735 AVENUE W
Practice Address - Street 2:APT. 5R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5551
Practice Address - Country:US
Practice Address - Phone:718-551-8125
Practice Address - Fax:718-551-8125
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist