Provider Demographics
NPI:1467687293
Name:VILLALOBOS, AMIILIS MIRANDA (P,T,)
Entity Type:Individual
Prefix:
First Name:AMIILIS
Middle Name:MIRANDA
Last Name:VILLALOBOS
Suffix:
Gender:F
Credentials:P,T,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7124 TIERRA TAOS DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7670
Mailing Address - Country:US
Mailing Address - Phone:915-227-9466
Mailing Address - Fax:
Practice Address - Street 1:5001 N. PIEDRAS STREET
Practice Address - Street 2:VA HEALTHCARE SYSTEM
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79930
Practice Address - Country:US
Practice Address - Phone:915-564-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist