Provider Demographics
NPI:1366712267
Name:VELAZQUEZ, JOHANNY B (LMT)
Entity type:Individual
Prefix:
First Name:JOHANNY
Middle Name:B
Last Name:VELAZQUEZ
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 1:190 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-3128
Mailing Address - Country:US
Mailing Address - Phone:305-883-0801
Mailing Address - Fax:
Practice Address - Street 1:190 E 16TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3128
Practice Address - Country:US
Practice Address - Phone:305-883-0801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43848225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist