Healthcare Provider Details

I. General information

NPI: 1942167432
Provider Name (Legal Business Name): MR. VICTOR MANUEL VILLA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4673 SW 129TH PL
OCALA FL
34473
UM

IV. Provider business mailing address

4673 SW 129TH PL
OCALA FL
34473
UM

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA108484
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: