Provider Demographics
NPI:1831304864
Name:VELAZQUEZ, VANESSA (PT, MBA)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:PT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190834
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-0016
Mailing Address - Country:US
Mailing Address - Phone:781-820-6363
Mailing Address - Fax:
Practice Address - Street 1:41 POPLAR ST
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-2505
Practice Address - Country:US
Practice Address - Phone:617-323-8013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist