Provider Demographics
NPI:1932842739
Name:VILLAMOR, HAZEL (PT)
Entity Type:Individual
Prefix:
First Name:HAZEL
Middle Name:
Last Name:VILLAMOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9745 TOUCHTON RD UNIT 2227
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-1521
Mailing Address - Country:US
Mailing Address - Phone:904-497-6083
Mailing Address - Fax:904-209-6757
Practice Address - Street 1:1700 WELLS RD STE 22
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2374
Practice Address - Country:US
Practice Address - Phone:904-209-4714
Practice Address - Fax:904-209-6757
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPT10622208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation