Individual
BENITO VELASQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC LAT
Contact information
Practice address
118 COLLEGE DR # 5142, UNIVERSITY OF SOUTHERN MISSISSIPPI, HATTIESBURG, MS 39406-0001
(601) 266-6058
(601) 266-4445
Mailing address
3410 TAFT BLVD, WICHITA FALLS, TX 76308-2099
(940) 397-4829
(940) 397-4901
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AT 0113
MS
2255A2300X
Athletic Trainer
Primary
AT4914
TX
Other
Enumeration date
03/24/2007
Last updated
08/04/2014
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