MEDICARE: MR. ARMANDO VILLENA DE JESUS JR. PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501009365	MI

General Provider Information

NPI Number	:	1346259785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ARMANDO VILLENA DE JESUS JR. PT

Provider Business Mailing Address
First Line	:	36588 GREGORY DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48312-2815
Country	:	US
Telephone Number	:	586-795-4339
Fax Number	:

Provider Business Practice Location Address
First Line	:	36588 GREGORY DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48312-2815
Country	:	US
Telephone Number	:	586-795-4339
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	10/25/2007

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