Healthcare Provider Details

I. General information

NPI: 1376465146
Provider Name (Legal Business Name): KATHERINE VILLOTA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 BEAM LN
FISHERSVILLE VA
22939-2348
US

IV. Provider business mailing address

5790 PONY FARM DR APT 301
RICHMOND VA
23227-4908
US

V. Phone/Fax

Practice location:
  • Phone: 540-213-7750
  • Fax:
Mailing address:
  • Phone: 703-244-0596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number0001310321
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: