Provider Demographics
NPI:1588631956
Name:VILLANO, KATHLEEN GAY GAMBOA (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN GAY
Middle Name:GAMBOA
Last Name:VILLANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHLEEN GAY
Other - Middle Name:GENOSA
Other - Last Name:GAMBOA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2942 PALADIUM DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8044
Mailing Address - Country:US
Mailing Address - Phone:972-641-0215
Mailing Address - Fax:972-641-0215
Practice Address - Street 1:2942 PALADIUM DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8044
Practice Address - Country:US
Practice Address - Phone:972-641-0215
Practice Address - Fax:972-641-0215
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1067650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist