Provider Demographics
NPI:1609405646
Name:VILLARREAL, SAMANTHA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N SCENIC HWY
Mailing Address - Street 2:
Mailing Address - City:BABSON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33827-9751
Mailing Address - Country:US
Mailing Address - Phone:863-638-2989
Mailing Address - Fax:
Practice Address - Street 1:1201 N SCENIC HWY
Practice Address - Street 2:
Practice Address - City:BABSON PARK
Practice Address - State:FL
Practice Address - Zip Code:33827-9751
Practice Address - Country:US
Practice Address - Phone:863-638-1431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer