Provider Demographics
NPI:1366272486
Name:ONE PLACE PERFORMANCE AND OSTEOPRACTIC PHYSICAL THERAPY
Entity type:Organization
Organization Name:ONE PLACE PERFORMANCE AND OSTEOPRACTIC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DELGADO
Authorized Official - Last Name:VELASCO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-549-3299
Mailing Address - Street 1:17532 CANTARINA CV
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-1151
Mailing Address - Country:US
Mailing Address - Phone:347-549-3299
Mailing Address - Fax:
Practice Address - Street 1:8039 COOPER CREEK BLVD STE 102
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:FL
Practice Address - Zip Code:34201-3007
Practice Address - Country:US
Practice Address - Phone:347-549-3299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty