Provider Demographics
NPI:1558601286
Name:VILLAFUERTE, ANTHONY PAUL AQUINO
Entity Type:Individual
Prefix:
First Name:ANTHONY PAUL
Middle Name:AQUINO
Last Name:VILLAFUERTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WHITE HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:18661-2724
Mailing Address - Country:US
Mailing Address - Phone:570-579-6189
Mailing Address - Fax:
Practice Address - Street 1:22 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:WHITE HAVEN
Practice Address - State:PA
Practice Address - Zip Code:18661-2724
Practice Address - Country:US
Practice Address - Phone:570-579-6189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-16
Last Update Date:2013-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist