Provider Demographics
NPI:1922056100
Name:VELAZQUEZ PRADOS, DENISE (PT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:VELAZQUEZ PRADOS
Suffix:
Gender:F
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:MP21 PLAZA 32
Mailing Address - Street 2:MONTE CLARO
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3574
Mailing Address - Country:US
Mailing Address - Phone:787-307-7939
Mailing Address - Fax:
Practice Address - Street 1:MP21 PLAZA 32
Practice Address - Street 2:MONTE CLARO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3574
Practice Address - Country:US
Practice Address - Phone:787-307-7939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0021429Medicare ID - Type UnspecifiedPROVIDER NUMBER