Provider Demographics
NPI:1225198245
Name:VILLAESPN, EDWIN M (PT)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:M
Last Name:VILLAESPN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 RIVER RUN RD W
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AL
Mailing Address - Zip Code:35907-6903
Mailing Address - Country:US
Mailing Address - Phone:256-442-2152
Mailing Address - Fax:
Practice Address - Street 1:409 E 10TH ST STE 305
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4781
Practice Address - Country:US
Practice Address - Phone:256-238-0110
Practice Address - Fax:256-238-5143
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1696174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPTH1696OtherPHYSICAL THERAPIST LICENS