Provider Demographics
NPI:1518229517
Name:VILLANUEVA, EDMUNDO LABIAL JR (RPT)
Entity Type:Individual
Prefix:MR
First Name:EDMUNDO
Middle Name:LABIAL
Last Name:VILLANUEVA
Suffix:JR
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 S LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2518
Mailing Address - Country:US
Mailing Address - Phone:863-682-6182
Mailing Address - Fax:
Practice Address - Street 1:5151 S LAKELAND DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2518
Practice Address - Country:US
Practice Address - Phone:863-682-6182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist