Individual
MR. ILDE BOY TAN VELASCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
3500 CENTURY DR, GRANITE CITY, IL 62040-2166
(618) 877-2700
Mailing address
4503 E FOXMOOR LN, LAFAYETTE, IN 47905-8562
(765) 421-9840
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
08/02/2022
Last updated
08/02/2022
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