Healthcare Provider Details

I. General information

NPI: 1023882693
Provider Name (Legal Business Name): TOMAS MUNILLA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ERWIN RD
DURHAM NC
27705-4699
US

IV. Provider business mailing address

3309 SPRUNT AVE
DURHAM NC
27705-3026
US

V. Phone/Fax

Practice location:
  • Phone: 919-681-2030
  • Fax:
Mailing address:
  • Phone: 484-472-2077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: