Provider Demographics
NPI:1821820044
Name:VILLANTE, MICHAEL THOMAS (PT,DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL THOMAS
Middle Name:
Last Name:VILLANTE
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 1:1804 NOBLE ST
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4019
Mailing Address - Country:US
Mailing Address - Phone:516-754-0547
Mailing Address - Fax:
Practice Address - Street 1:2555 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2152
Practice Address - Country:US
Practice Address - Phone:516-234-7795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist