Healthcare Provider Details

I. General information

NPI: 1902668601
Provider Name (Legal Business Name): LEONARDO PADIN VILLANUEVA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 UNIVERSITY BLVD S STE A8
JACKSONVILLE FL
32216-4210
US

IV. Provider business mailing address

7901 4TH ST N # 24927
ST PETERSBURG FL
33702-4305
US

V. Phone/Fax

Practice location:
  • Phone: 904-553-4900
  • Fax:
Mailing address:
  • Phone: 904-456-9293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT44821
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: