Provider Demographics
NPI:1689982563
Name:VILLORIA, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:VILLORIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2336
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34991-7336
Mailing Address - Country:US
Mailing Address - Phone:772-224-4472
Mailing Address - Fax:
Practice Address - Street 1:3741 SW COQUINA COVE WAY
Practice Address - Street 2:#202
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-8173
Practice Address - Country:US
Practice Address - Phone:772-224-4472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 9824224Z00000X
FLMA25967225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant