MEDICARE: FABIANA BASTOS VILLARI DPT

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	225200000X	Physical Therapy Assistant	2089557	TX
2	225100000X	Physical Therapist	3129659	TX

General Provider Information

NPI Number	:	1689300816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FABIANA BASTOS VILLARI DPT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	866-370-8206
Fax Number	:

Provider Business Practice Location Address
First Line	:	4617 W BAILEY BOSWELL RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-4327
Country	:	US
Telephone Number	:	682-350-4206
Fax Number	:	254-249-1594

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

Provider Enumeration Date	:	07/29/2022
Last Update Date	:	12/20/2022

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