Provider Demographics
NPI:1871794123
Name:VELEZ, JACQUELINE A (PT)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:A
Last Name:VELEZ
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 1:51-55 N. ROUTE 9 W
Mailing Address - Street 2:
Mailing Address - City:WEST HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10993
Mailing Address - Country:US
Mailing Address - Phone:845-786-4208
Mailing Address - Fax:845-786-4022
Practice Address - Street 1:51-55 N. ROUTE 9 W
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993
Practice Address - Country:US
Practice Address - Phone:845-786-4208
Practice Address - Fax:845-786-4022
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014299-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist