Provider Demographics
NPI:1891970133
Name:VELARDE, MYLEENE SALVADOR
Entity Type:Individual
Prefix:
First Name:MYLEENE
Middle Name:SALVADOR
Last Name:VELARDE
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 1:1920 OLD SPRINGVILLE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-5858
Mailing Address - Country:US
Mailing Address - Phone:205-520-9600
Mailing Address - Fax:205-520-0455
Practice Address - Street 1:1920 OLD SPRINGVILLE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-5858
Practice Address - Country:US
Practice Address - Phone:205-520-9600
Practice Address - Fax:205-520-0455
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-06
Last Update Date:2008-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.015859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist