Provider Demographics
NPI:1811413537
Name:VILLANUEVA, JASONRIC AQUINO (PT)
Entity Type:Individual
Prefix:MR
First Name:JASONRIC
Middle Name:AQUINO
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 PENFIELD LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1426
Mailing Address - Country:US
Mailing Address - Phone:240-484-0657
Mailing Address - Fax:240-206-9487
Practice Address - Street 1:352A CHRISTOPHER AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3660
Practice Address - Country:US
Practice Address - Phone:301-977-6400
Practice Address - Fax:301-977-6400
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist