Provider Demographics
NPI:1417793829
Name:VELASQUEZ, WILLIAM (LMT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:VELASQUEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6250 ROOSEVELT BLVD LOT 55
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-2587
Mailing Address - Country:US
Mailing Address - Phone:720-432-8295
Mailing Address - Fax:
Practice Address - Street 1:2675 GULF TO BAY BLVD STE 710
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-4946
Practice Address - Country:US
Practice Address - Phone:720-432-8295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-04
Last Update Date:2024-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA88473225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist