Provider Demographics
NPI:1609391028
Name:MUNIZ-VILLAGRA, FERNANDO (PT)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:MUNIZ-VILLAGRA
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 1:2108 S M ST STE 6
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1556
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6501 S CONGRESS AVE STE 301
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-4483
Practice Address - Country:US
Practice Address - Phone:512-270-2060
Practice Address - Fax:512-270-2061
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1284218225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1284218OtherTEXAS PHYSICAL THERAPY LICENSE