Provider Demographics
NPI:1104055375
Name:VONVILLAS, SUSAN ASHLEY (PT, MS, DPT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ASHLEY
Last Name:VONVILLAS
Suffix:
Gender:F
Credentials:PT, MS, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:22702 NEWCOURT PLACE STREET
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-1125
Mailing Address - Country:US
Mailing Address - Phone:281-546-1228
Mailing Address - Fax:832-761-0308
Practice Address - Street 1:22702 NEWCOURT PLACE STREET
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-1125
Practice Address - Country:US
Practice Address - Phone:281-546-1228
Practice Address - Fax:832-761-0308
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11716802251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283158801Medicaid