Provider Demographics
NPI:1669751012
Name:VILLA, TIMOTHY FRANK
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:FRANK
Last Name:VILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 OHIO DR STE 130
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3997
Mailing Address - Country:US
Mailing Address - Phone:972-964-0200
Mailing Address - Fax:972-519-0042
Practice Address - Street 1:2301 OHIO DR STE 130
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3997
Practice Address - Country:US
Practice Address - Phone:972-964-0200
Practice Address - Fax:972-519-0042
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107979235Z00000X
MI7101004969235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149984001Medicaid
TX207164901Medicaid
TX676535Medicare PIN
TX456606Medicare PIN