Healthcare Provider Details

I. General information

NPI: 1013104207
Provider Name (Legal Business Name): FERNANDO ANTONIO VILLAR P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: FERNANDO ANTONIO VILLAR P.T

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E FOOTHILL BLVD STE 100
ARCADIA CA
91006-2314
US

IV. Provider business mailing address

50 E FOOTHILL BLVD SUITE 100
ARCADIA CA
91006-2314
US

V. Phone/Fax

Practice location:
  • Phone: 626-445-2400
  • Fax:
Mailing address:
  • Phone: 626-445-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT14116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: