MEDICARE: RAYMUNDO C VILLARREAL LPT

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
1	2251X0800X	Orthopedic Physical Therapist	1026771	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1026771	OTHER	TX	PHYSICAL THERAPIST LICENS

General Provider Information

NPI Number	:	1528053592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMUNDO C VILLARREAL LPT

Provider Business Mailing Address
First Line	:	1104B W SAM HOUSTON ST
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-5104
Country	:	US
Telephone Number	:	956-787-0962
Fax Number	:	956-787-1564

Provider Business Practice Location Address
First Line	:	1104B W SAM HOUSTON ST
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-5104
Country	:	US
Telephone Number	:	956-787-0962
Fax Number	:	956-787-1564

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	07/12/2007

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