Provider Demographics
NPI:1508550393
Name:VILLAROSA, GLAIZA MARIE
Entity Type:Individual
Prefix:
First Name:GLAIZA MARIE
Middle Name:
Last Name:VILLAROSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 SAVANNAH LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-5089
Mailing Address - Country:US
Mailing Address - Phone:630-642-4486
Mailing Address - Fax:
Practice Address - Street 1:487 SAVANNAH LN
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-5089
Practice Address - Country:US
Practice Address - Phone:630-642-4486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist