Healthcare Provider Details

I. General information

NPI: 1740806553
Provider Name (Legal Business Name): ARMANDO DAVID VILLARREAL PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 N OAK ST STE 220
ROANOKE TX
76262-6105
US

IV. Provider business mailing address

409 N OAK STREET SUITE 220
FORT WORTH TX
76244-9465
US

V. Phone/Fax

Practice location:
  • Phone: 682-502-4440
  • Fax:
Mailing address:
  • Phone: 682-502-4440
  • Fax: 682-502-4490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1330963
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: