Healthcare Provider Details

I. General information

NPI: 1043220064
Provider Name (Legal Business Name): RHOGER L VILLALON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 PEMBERTON HILL RD STE 201
APEX NC
27502-4267
US

IV. Provider business mailing address

981 HIGH HOUSE RD STE 100
CARY NC
27513-3510
US

V. Phone/Fax

Practice location:
  • Phone: 919-388-0111
  • Fax: 919-388-8668
Mailing address:
  • Phone: 919-388-0111
  • Fax: 919-388-8668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10589
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21248
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier067X4
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS OF NC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: