Active NPI
Edward Velasco
- Physical Therapist
- Tawas City, MI
National Provider Identifier
1750712840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3501011383
- Practice address
- 400 North St W
Tawas City, MI 48763-9161 - Phone
- (989) 362-8647
- NPI assigned
- Nov 27, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 3501011383 | MI | Primary |
Addresses
Primary practice location
400 North St W
Tawas City, MI 48763-9161
Mailing address
4630 McNichol Ave
Oscoda, MI 48750-1512
Phone (989) 739-3722
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3501011383 | MI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peak Rehab LLC | Physical Therapist | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Bay City, MI
- NPI 1629831219
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1385510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1385510400000",
"number": "1750712840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4630 MCNICHOL AVE",
"city": "OSCODA",
"state": "MI",
"postal_code": "487501512",
"telephone_number": "989-739-3722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 NORTH ST W",
"city": "TAWAS CITY",
"state": "MI",
"postal_code": "487639161",
"telephone_number": "989-362-8647"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VELASCO",
"first_name": "EDWARD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-11-27",
"last_updated": "2013-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "3501011383",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tawas City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.