Provider Demographics
NPI:1396756193
Name:VILLAFUERTE, JENNA E (LPTA)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:E
Last Name:VILLAFUERTE
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2662 MCFARLAND RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6806
Mailing Address - Country:US
Mailing Address - Phone:815-227-1700
Mailing Address - Fax:815-227-1744
Practice Address - Street 1:2662 MCFARLAND RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6806
Practice Address - Country:US
Practice Address - Phone:815-227-1700
Practice Address - Fax:815-227-1744
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160-002768225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL160-002768OtherPROFESSIONAL LICENSE