Provider Demographics
NPI:1508145350
Name:VILLARREAL, KIMBERLY M (LMT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7835 CLIPPER PASS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254
Mailing Address - Country:US
Mailing Address - Phone:210-875-7151
Mailing Address - Fax:210-641-8324
Practice Address - Street 1:6222 DE ZAVALA RD
Practice Address - Street 2:STE 204
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249
Practice Address - Country:US
Practice Address - Phone:210-875-7151
Practice Address - Fax:210-641-8324
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT113452225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist