MEDICARE: VIRNA LIZA TAMETA 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
1	225100000X	Physical Therapist	014898	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Q08C11	OTHER	NY	BCBS

General Provider Information

NPI Number	:	1750391876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRNA LIZA TAMETA VILLANUEVA PT

Provider Business Mailing Address
First Line	:	2050 SAW MILL RIVER RD
Second Line	:	2ND FLOOR
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4108
Country	:	US
Telephone Number	:	914-962-0100
Fax Number	:	914-962-0105

Provider Business Practice Location Address
First Line	:	2050 SAW MILL RIVER RD
Second Line	:	2ND FLOOR
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4108
Country	:	US
Telephone Number	:	914-962-0100
Fax Number	:	914-962-0105

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/08/2007

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Directions to “ VIRNA LIZA TAMETA VILLANUEVA PT” Practice Location

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