Provider Demographics
NPI:1154582294
Name:VELOZ, SELENE A (DPT)
Entity type:Individual
Prefix:MRS
First Name:SELENE
Middle Name:A
Last Name:VELOZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SELENE
Other - Middle Name:A
Other - Last Name:NANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 31630
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1630
Mailing Address - Country:US
Mailing Address - Phone:520-784-6570
Mailing Address - Fax:520-784-6575
Practice Address - Street 1:8275 N SILVERBELL RD STE 113
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-5307
Practice Address - Country:US
Practice Address - Phone:520-382-8202
Practice Address - Fax:520-784-6575
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ439583Medicaid