Provider Demographics
NPI:1922125814
Name:VILLAVER, ELLEN GRACE (MSPT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:GRACE
Last Name:VILLAVER
Suffix:
Gender:F
Credentials:MSPT, DPT
Other - Prefix:MRS
Other - First Name:ELLEN GRACE
Other - Middle Name:ESPIRITU
Other - Last Name:VILLAVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPT, DPT
Mailing Address - Street 1:PO BOX 1769
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20118-1769
Mailing Address - Country:US
Mailing Address - Phone:540-687-8181
Mailing Address - Fax:540-687-8256
Practice Address - Street 1:150 ELDEN ST
Practice Address - Street 2:SUITE 242
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4861
Practice Address - Country:US
Practice Address - Phone:703-689-3737
Practice Address - Fax:703-689-3889
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist