Provider Demographics
NPI:1699426973
Name:VELEZ, BRIAN ERNEST (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ERNEST
Last Name:VELEZ
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 RICE RD APT 920
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1092
Mailing Address - Country:US
Mailing Address - Phone:304-844-1867
Mailing Address - Fax:
Practice Address - Street 1:761 RICE RD APT 920
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1092
Practice Address - Country:US
Practice Address - Phone:304-844-1867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5849225700000X
MS2860225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist