Provider Demographics
NPI:1710467451
Name:VILLARREAL, HUGH VINCENT (PTA)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:VINCENT
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 FOREST BEND DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-6106
Mailing Address - Country:US
Mailing Address - Phone:214-250-3259
Mailing Address - Fax:972-517-3436
Practice Address - Street 1:8000 ELDORADO PKWY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4136
Practice Address - Country:US
Practice Address - Phone:972-569-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2021960225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty