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General NPI Number Information
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NPI Number | 1801914031
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Entity Type | Individual
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Provider Name | LITO B VILLANUEVA PT
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 02/06/2020
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Provider Practice Location Address
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Address Line | 12622 PORTMARNOCK DR
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City | ODESSA
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State | FL
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Zip | 33556-5414
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Country | US
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Telephone | 573-353-0285
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Fax |
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Provider Business Mailing Address
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Address Line | 12622 PORTMARNOCK DR
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City | ODESSA
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State | FL
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Zip | 33556-5414
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Country | US
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Telephone | 573-353-0285
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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 | 02207
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 24312
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License Number State | FL
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