Provider Demographics
NPI:1497975056
Name:VILLASENOR, DAVID ALAN (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:VILLASENOR
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 1:1207 MAY LN
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-5628
Mailing Address - Country:US
Mailing Address - Phone:918-333-5145
Mailing Address - Fax:
Practice Address - Street 1:3550 E FRANK PHILLIPS BLVD
Practice Address - Street 2:JANE PHILLIPS PHYSICAL MEDICINE CENTER
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2411
Practice Address - Country:US
Practice Address - Phone:918-331-1594
Practice Address - Fax:918-331-1631
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist