Provider Demographics
NPI:1104151356
Name:VELA, SANDRA (LMT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:VELA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3428 TUMBLING RIVER DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8958
Mailing Address - Country:US
Mailing Address - Phone:407-461-0776
Mailing Address - Fax:352-394-8000
Practice Address - Street 1:1705 E HWY 50
Practice Address - Street 2:SUITE B
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5186
Practice Address - Country:US
Practice Address - Phone:352-394-7577
Practice Address - Fax:352-394-8000
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 55765225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist