Provider Demographics
NPI:1992023915
Name:VILLANUEVA, ANGELICA (MSPT)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0141
Mailing Address - Country:US
Mailing Address - Phone:787-546-7114
Mailing Address - Fax:
Practice Address - Street 1:BO CRUCES CARR 414
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-0141
Practice Address - Country:US
Practice Address - Phone:787-546-7114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist