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NPI Code Detail

MEDICARE: GRACE VILLANUEVA

MEDICARE: GRACE VILLANUEVA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistLA

General Provider Information

NPI Number : 1063851533
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE VILLANUEVA
Provider Business Mailing Address
First Line : 4109 HIGHWAY 98 W
Second Line :
City : SUMMIT
State : MS
Zip : 39666-9132
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 804 POLK ST
Second Line :
City : WINNSBORO
State : LA
Zip : 71295-2350
Country : US
Telephone Number : 318-435-1550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2013
Last Update Date : 06/18/2013

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Directions to “ GRACE VILLANUEVA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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