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General NPI Number Information
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NPI Number | 1508145350
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Entity Type | Individual
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Provider Name | KIMBERLY M VILLARREAL LMT
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Gender | Female
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 12/11/2013
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Provider Practice Location Address
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Address Line | 6222 DE ZAVALA RD STE 204
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City | SAN ANTONIO
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State | TX
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Zip | 78249
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Country | US
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Telephone | 210-875-7151
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Fax | 210-641-8324
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Provider Business Mailing Address
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Address Line | 7835 CLIPPER PASS
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City | SAN ANTONIO
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State | TX
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Zip | 78254
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Country | US
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Telephone | 210-875-7151
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Fax | 210-641-8324
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT113452
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License Number State | TX
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