MR. Ilde Boy Tan Velasco, PT, DPT

NPI #1316674112 in Granite City, Illinois

Provider Information

NPI Number: 1316674112
Entity Type: Individual
Name: MR. Ilde Boy Tan Velasco, PT, DPT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physical Therapist
Credential: PT, DPT
Enumeration Date: Aug 2, 2022
Last Updated: Aug 2, 2022

Practice Location

Address: 3500 CENTURY DR
City: Granite City
State: Illinois
ZIP Code: 62040-2166
Phone: (618) 877-2700

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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