Provider Demographics
NPI:1922348341
Name:VELASQUEZ, HARVEY FERNANDEZ (PT)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:FERNANDEZ
Last Name:VELASQUEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2791 BOBBY JONES ST
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-6611
Mailing Address - Country:US
Mailing Address - Phone:305-607-3100
Mailing Address - Fax:
Practice Address - Street 1:1431 OAK ST APT 10
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3163
Practice Address - Country:US
Practice Address - Phone:305-607-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist