Provider Demographics
NPI:1790476406
Name:VILLARUZ, DANIELLE MONICA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MONICA
Last Name:VILLARUZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:DANI
Other - Middle Name:
Other - Last Name:VILLARUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 1189
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1189
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:845 SW 30TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331-8629
Practice Address - Country:US
Practice Address - Phone:541-768-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
390200000X
OR64945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program