MEDICARE: MARIE BEATRICE INOCENCIO VILLARUEL 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
1	225100000X	Physical Therapist	PT 10996	FL

General Provider Information

NPI Number	:	1588753180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE BEATRICE INOCENCIO VILLARUEL PT

Provider Business Mailing Address
First Line	:	2745 CITRUS TOWER BLVD
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-6699
Country	:	US
Telephone Number	:	352-241-4111
Fax Number	:	352-241-4113

Provider Business Practice Location Address
First Line	:	518 JOHNS LANDING WAY
Second Line	:
City	:	OAKLAND
State	:	FL
Zip	:	34787-8984
Country	:	US
Telephone Number	:	407-877-3534
Fax Number	:

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	10/23/2020

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