Provider Demographics
NPI:1134740731
Name:VELASQUEZ, PEDRO III (PTA,CMRT,MA)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:VELASQUEZ
Suffix:III
Gender:M
Credentials:PTA,CMRT,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18867 FM 1314 RD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77302-5925
Mailing Address - Country:US
Mailing Address - Phone:832-428-4962
Mailing Address - Fax:
Practice Address - Street 1:18867 FM 1314 RD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77302-5925
Practice Address - Country:US
Practice Address - Phone:832-428-4962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2052190225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant