Provider Demographics
NPI:1669955050
Name:VELIAOTS, IRENA
Entity type:Individual
Prefix:
First Name:IRENA
Middle Name:
Last Name:VELIAOTS
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 1:5637 SIRAGUSA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6178
Mailing Address - Country:US
Mailing Address - Phone:917-870-0455
Mailing Address - Fax:
Practice Address - Street 1:1500 COTTONWOOD CREEK TRL
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7555
Practice Address - Country:US
Practice Address - Phone:512-259-4259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2140696225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant