Provider Demographics
NPI:1235403098
Name:VILLAREAL, CESAR (RPT)
Entity Type:Individual
Prefix:MR
First Name:CESAR
Middle Name:
Last Name:VILLAREAL
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 LISSON LN
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3386
Mailing Address - Country:US
Mailing Address - Phone:901-690-4442
Mailing Address - Fax:901-861-3869
Practice Address - Street 1:1737 LISSON LN
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3386
Practice Address - Country:US
Practice Address - Phone:901-690-4442
Practice Address - Fax:901-861-3869
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-25
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist