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NPI Code Detail

MEDICARE: MR. CARL JASON ANTONIL VILLANUEVA PT

MEDICARE: MR. CARL JASON ANTONIL VILLANUEVA PT
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 Therapist8040NC

General Provider Information

NPI Number : 1467611905
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CARL JASON ANTONIL VILLANUEVA PT
Provider Business Mailing Address
First Line : 2015 HUNTERS RIDGE DR
Second Line :
City : MIDWAY PARK
State : NC
Zip : 28544-1635
Country : US
Telephone Number : 910-577-1210
Fax Number :
Provider Business Practice Location Address
First Line : 1839 ONSLOW DR
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28540-5906
Country : US
Telephone Number : 910-455-3610
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2008
Last Update Date : 06/09/2008

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