Provider Demographics
NPI:1972991602
Name:VELAZQUEZ, BRENDA (RPT)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 11431
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9779
Mailing Address - Country:US
Mailing Address - Phone:787-566-7221
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 11431
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-9779
Practice Address - Country:US
Practice Address - Phone:787-566-7221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist