Healthcare Provider Details

I. General information

NPI: 1154096014
Provider Name (Legal Business Name): VILLANI PHYSICAL THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 MASSELIN AVE APT 107
LOS ANGELES CA
90036-5759
US

IV. Provider business mailing address

630 MASSELIN AVE APT 107
LOS ANGELES CA
90036-5759
US

V. Phone/Fax

Practice location:
  • Phone: 323-715-2764
  • Fax:
Mailing address:
  • Phone: 323-715-2764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARIA AUGUSTA ARTENCIO VILLANI
Title or Position: CEO
Credential: PHYSICAL THERAPIST
Phone: 323-715-2764