Provider Demographics
NPI:1922211325
Name:VELASCO, RICARDO MELEGRITO (PT)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:MELEGRITO
Last Name:VELASCO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:RIC
Other - Middle Name:
Other - Last Name:VELASCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:4630 MCNICHOL AVE
Mailing Address - Street 2:
Mailing Address - City:OSCODA
Mailing Address - State:MI
Mailing Address - Zip Code:48750-1512
Mailing Address - Country:US
Mailing Address - Phone:732-232-6725
Mailing Address - Fax:
Practice Address - Street 1:110 BEECH STREET
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48764
Practice Address - Country:US
Practice Address - Phone:989-362-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL8933225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist