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General NPI Number Information
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NPI Number | 1477893931
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Entity Type | Individual
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Provider Name | JEANNIE FRANCES LARIOSA VILLAMANTE RPT, DPT
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Gender | Female
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Dates
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Enumeration Date | 02/21/2013
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Last Update Date | 02/21/2013
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Provider Practice Location Address
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Address Line | 652 W AVON RD
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City | AVON
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State | CT
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Zip | 06001-2906
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Country | US
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Telephone | 860-673-2521
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Fax |
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Provider Business Mailing Address
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Address Line | 1175 FARMINGTON AVE APT 2-403
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City | BRISTOL
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State | CT
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Zip | 06010-4730
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Country | US
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Telephone | 860-518-4623
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 008125
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License Number State | CT
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