Provider Demographics
NPI:1700560968
Name:VILLARTA, KNELL ANTHONY SORIANO (PA)
Entity Type:Individual
Prefix:
First Name:KNELL
Middle Name:ANTHONY SORIANO
Last Name:VILLARTA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 K ST NW STE 615
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1066
Mailing Address - Country:US
Mailing Address - Phone:202-808-8295
Mailing Address - Fax:
Practice Address - Street 1:2021 K ST NW STE 615
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1066
Practice Address - Country:US
Practice Address - Phone:202-808-8295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC46-34698542081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine