Provider Demographics
NPI:1003393497
Name:VILLARREAL, KATHERINE LEE (DPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LEE
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 W HORIZON RIDGE PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5062
Mailing Address - Country:US
Mailing Address - Phone:702-294-7498
Mailing Address - Fax:
Practice Address - Street 1:2930 W HORIZON PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-294-7498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist