Provider Demographics
NPI:1356161566
Name:VILLAREAL, ERMOL VALENZUELA JR (PTA)
Entity type:Individual
Prefix:
First Name:ERMOL
Middle Name:VALENZUELA
Last Name:VILLAREAL
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:608 MAIDSTONE CT
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-3365
Mailing Address - Country:US
Mailing Address - Phone:302-212-9075
Mailing Address - Fax:
Practice Address - Street 1:608 MAIDSTONE CT
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-3365
Practice Address - Country:US
Practice Address - Phone:302-212-9075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant