Provider Demographics
NPI:1245328715
Name:VELAZQUEZ, EMILIA (MSPT)
Entity type:Individual
Prefix:MRS
First Name:EMILIA
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 AUTUMN HILL DR
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-2043
Mailing Address - Country:US
Mailing Address - Phone:732-589-0550
Mailing Address - Fax:
Practice Address - Street 1:21 KILMER DR
Practice Address - Street 2:BLDG. 2 SUITE D
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1571
Practice Address - Country:US
Practice Address - Phone:732-851-7607
Practice Address - Fax:732-851-7610
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00678300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ046199Medicare ID - Type Unspecified