Healthcare Provider Details

I. General information

NPI: 1396267977
Provider Name (Legal Business Name): MARTIN RAMON VILLARREAL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N ED CAREY DR STE A
HARLINGEN TX
78550-7914
US

IV. Provider business mailing address

702 N ED CAREY DR STE A
HARLINGEN TX
78550-7914
US

V. Phone/Fax

Practice location:
  • Phone: 956-440-1155
  • Fax: 956-440-0913
Mailing address:
  • Phone: 956-440-1155
  • Fax: 956-440-0913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1199789
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: