Provider Demographics
NPI:1548223886
Name:VILLANUEVA, JOSE A (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:VILLANUEVA
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 1:8603 N LOOP 1604 W
Mailing Address - Street 2:#11119
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2601
Mailing Address - Country:US
Mailing Address - Phone:210-257-5420
Mailing Address - Fax:
Practice Address - Street 1:12980 BANDERA RD
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4098
Practice Address - Country:US
Practice Address - Phone:210-372-9600
Practice Address - Fax:210-372-9923
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25927225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist