Provider Demographics
NPI:1306016217
Name:ASIS, RISSA VILLAREAL (PT)
Entity Type:Individual
Prefix:MS
First Name:RISSA
Middle Name:VILLAREAL
Last Name:ASIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 W. 5TH ST.
Mailing Address - Street 2:GMMPCPI
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-2501
Mailing Address - Country:US
Mailing Address - Phone:417-782-2917
Mailing Address - Fax:417-782-7038
Practice Address - Street 1:214 W. 5TH ST.
Practice Address - Street 2:GMMPCPI
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-2501
Practice Address - Country:US
Practice Address - Phone:417-782-2917
Practice Address - Fax:417-782-7038
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008005755225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist