Provider Demographics
NPI:1043450323
Name:TIRAO, JOAN VELASCO (PT)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:VELASCO
Last Name:TIRAO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6074 SE 91ST TRL
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-1436
Mailing Address - Country:US
Mailing Address - Phone:863-447-0842
Mailing Address - Fax:
Practice Address - Street 1:725 S PINE ST
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-3654
Practice Address - Country:US
Practice Address - Phone:863-385-0161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24501225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist