Provider Demographics
NPI:1730461898
Name:GO, LOVELY MONA GRACE VILLANUEVA (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:LOVELY MONA GRACE
Middle Name:VILLANUEVA
Last Name:GO
Suffix:
Gender:F
Credentials:PT, DPT
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 970583
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-0583
Mailing Address - Country:US
Mailing Address - Phone:808-772-8399
Mailing Address - Fax:808-378-3152
Practice Address - Street 1:85-979 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-2678
Practice Address - Country:US
Practice Address - Phone:808-428-9261
Practice Address - Fax:808-378-3152
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-3206225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist