Provider Demographics
NPI:1912036369
Name:VILLANUEVA, SHARON ROSE (RPT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ROSE
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:ROSE
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:1714 SNARESBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6586
Mailing Address - Country:US
Mailing Address - Phone:407-859-9176
Mailing Address - Fax:
Practice Address - Street 1:1714 SNARESBROOK WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6586
Practice Address - Country:US
Practice Address - Phone:407-859-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist