Healthcare Provider Details

I. General information

NPI: 1205340270
Provider Name (Legal Business Name): JOSEPH EDWIN VILLACORTE ABRENICA BSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5741 157TH ST FL 1
FLUSHING NY
11355-5518
US

IV. Provider business mailing address

5741 157TH ST FL 1
FLUSHING NY
11355-5518
US

V. Phone/Fax

Practice location:
  • Phone: 850-832-9535
  • Fax:
Mailing address:
  • Phone: 850-832-9535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number039896-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number039896-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: