Provider Demographics
NPI:1841689619
Name:VELASQUEZ, MARC PAELO TUMAMAK (PTA)
Entity type:Individual
Prefix:MR
First Name:MARC PAELO
Middle Name:TUMAMAK
Last Name:VELASQUEZ
Suffix:
Gender:M
Credentials:PTA
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Mailing Address - Street 1:23061 VIA PIMIENTO
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23061 VIA PIMIENTO
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2833
Practice Address - Country:US
Practice Address - Phone:949-485-8188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-17
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAT 9762225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant