Provider Demographics
NPI:1245041763
Name:VILLANUEVA, CARLOS (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2177 S MCQUEEN RD APT 3098
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1852
Mailing Address - Country:US
Mailing Address - Phone:520-878-6772
Mailing Address - Fax:
Practice Address - Street 1:2140 E 5TH ST STE 8
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85288-3043
Practice Address - Country:US
Practice Address - Phone:480-474-4921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-034027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist