Provider Demographics
NPI:1003040536
Name:VILLAMIL, OLGA L
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:L
Last Name:VILLAMIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1578 WILLIAMSBRIDGE RD
Mailing Address - Street 2:SUITE 3D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-6265
Mailing Address - Country:US
Mailing Address - Phone:718-863-3292
Mailing Address - Fax:718-863-3290
Practice Address - Street 1:1578 WILLIAMSBRIDGE RD
Practice Address - Street 2:SUITE 3D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-6265
Practice Address - Country:US
Practice Address - Phone:718-863-3292
Practice Address - Fax:718-863-3290
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020083-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist