Provider Demographics
NPI:1477893931
Name:VILLAMANTE, JEANNIE FRANCES LARIOSA (RPT, DPT)
Entity Type:Individual
Prefix:
First Name:JEANNIE FRANCES
Middle Name:LARIOSA
Last Name:VILLAMANTE
Suffix:
Gender:F
Credentials:RPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 FARMINGTON AVE
Mailing Address - Street 2:APT 2-403
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4730
Mailing Address - Country:US
Mailing Address - Phone:860-518-4623
Mailing Address - Fax:
Practice Address - Street 1:652 W AVON RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-2906
Practice Address - Country:US
Practice Address - Phone:860-673-2521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist