Provider Demographics
NPI:1689300816
Name:VILLARI, FABIANA BASTOS (DPT)
Entity Type:Individual
Prefix:
First Name:FABIANA
Middle Name:BASTOS
Last Name:VILLARI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:FABIANA
Other - Middle Name:BASTOS
Other - Last Name:SILVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:
Practice Address - Street 1:4617 W BAILEY BOSWELL RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-4327
Practice Address - Country:US
Practice Address - Phone:682-350-4206
Practice Address - Fax:254-249-1594
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2089557225200000X
TX3129659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist