Healthcare Provider Details

I. General information

NPI: 1487889879
Provider Name (Legal Business Name): ARVI VILLANUEVA PTPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2494 WILLIAMSBRIDGE RD
BRONX NY
10469-4806
US

IV. Provider business mailing address

2494 WILLIAMSBRIDGE RD
BRONX NY
10469-4806
US

V. Phone/Fax

Practice location:
  • Phone: 718-652-1802
  • Fax:
Mailing address:
  • Phone: 718-652-1802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number023513
License Number StateNY

VIII. Authorized Official

Name: MISS ARVI MARIE VILLANUEVA
Title or Position: PRESIDENT
Credential: PT
Phone: 917-640-2504