Provider Demographics
NPI:1114142965
Name:VILLANUEVA, MA. DINA GRACE PANAGUITON (RPT)
Entity Type:Individual
Prefix:
First Name:MA. DINA GRACE
Middle Name:PANAGUITON
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:
Other - Last Name:VILLANUEVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1950 W LA BONTE CIR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-2318
Mailing Address - Country:US
Mailing Address - Phone:352-746-3215
Mailing Address - Fax:352-746-3215
Practice Address - Street 1:1950 W LA BONTE CIR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-2318
Practice Address - Country:US
Practice Address - Phone:352-746-3215
Practice Address - Fax:352-746-3215
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL009467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist