Provider Demographics
NPI:1013104207
Name:VILLAR, FERNANDO ANTONIO (PT)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:ANTONIO
Last Name:VILLAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:DR
Other - First Name:FERNANDO
Other - Middle Name:ANTONIO
Other - Last Name:VILLAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:50 E FOOTHILL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-2314
Mailing Address - Country:US
Mailing Address - Phone:626-445-2400
Mailing Address - Fax:
Practice Address - Street 1:50 E FOOTHILL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-2314
Practice Address - Country:US
Practice Address - Phone:626-445-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist