Individual
KELLY VASQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3387 GULF BREEZE PKWY, GULF BREEZE, FL 32563-3351
(850) 932-9257
Mailing address
6155 REDBERRY DR, GULF BREEZE, FL 32563-9778
(850) 496-5685
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA21426
FL
Other
Enumeration date
06/25/2018
Last updated
02/09/2021
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