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NPI Code Detail

MEDICARE: MRS. KRISTINE M VILLARTA P.T.

MEDICARE: MRS. KRISTINE M VILLARTA P.T.
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 Therapist21032MD
2225100000XPhysical Therapist2305213251VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427044189
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTINE M VILLARTA P.T.
Provider Business Mailing Address
First Line : 7503 SURRATTS RD
Second Line :
City : CLINTON
State : MD
Zip : 20735-3358
Country : US
Telephone Number : 301-870-7001
Fax Number : 302-870-6697
Provider Business Practice Location Address
First Line : 10 SAINT PATRICKS DR
Second Line : SUITE 401
City : WALDORF
State : MD
Zip : 20603-4527
Country : US
Telephone Number : 301-870-6717
Fax Number : 301-870-7366
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2005
Last Update Date : 10/25/2019

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