Provider Demographics
NPI:1952502874
Name:VILLAREAL, CONSEULO (RPT)
Entity Type:Individual
Prefix:
First Name:CONSEULO
Middle Name:
Last Name:VILLAREAL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2823 US HIGHWAY 301 N
Mailing Address - Street 2:STE 4
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-2084
Mailing Address - Country:US
Mailing Address - Phone:941-729-8600
Mailing Address - Fax:941-729-4440
Practice Address - Street 1:2823 US HIGHWAY 301 N
Practice Address - Street 2:STE 4
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-2084
Practice Address - Country:US
Practice Address - Phone:941-729-8600
Practice Address - Fax:941-729-4440
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3711CMedicare ID - Type UnspecifiedMEDICARE