Provider Demographics
NPI:1821115718
Name:VELARDE, LYNNUEL DOLIGOSA (DPT)
Entity Type:Individual
Prefix:MR
First Name:LYNNUEL
Middle Name:DOLIGOSA
Last Name:VELARDE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8902 LEEMORE CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2942
Mailing Address - Country:US
Mailing Address - Phone:502-599-9902
Mailing Address - Fax:502-426-5987
Practice Address - Street 1:7926 PRESTON HWY STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3848
Practice Address - Country:US
Practice Address - Phone:502-964-5404
Practice Address - Fax:502-964-6164
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist