Provider Demographics
NPI:1023296175
Name:VILLANUEVA, DONATO B JR (PT)
Entity type:Individual
Prefix:
First Name:DONATO
Middle Name:B
Last Name:VILLANUEVA
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HEATHER RDG
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-8320
Mailing Address - Country:US
Mailing Address - Phone:845-249-8617
Mailing Address - Fax:845-827-6095
Practice Address - Street 1:50 HEATHER RDG
Practice Address - Street 2:
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-8320
Practice Address - Country:US
Practice Address - Phone:845-249-8617
Practice Address - Fax:845-827-6095
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019340-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist