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General NPI Number Information
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NPI Number | 1477277028
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Entity Type | Individual
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Provider Name | ALVARO ROBINSON PRIETO VILLARRAGA OTA
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Gender | Male
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Dates
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Enumeration Date | 09/28/2022
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Last Update Date | 10/10/2022
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Provider Practice Location Address
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Address Line | 200 FRANK W BURR BLVD
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City | TEANECK
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State | NJ
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Zip | 07666-6728
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Country | US
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Telephone | 551-449-0135
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Fax |
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Provider Business Mailing Address
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Address Line | 200 FRANK W BURR BLVD
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City | TEANECK
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State | NJ
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Zip | 07666-6728
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Country | US
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Telephone | 551-449-0135
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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