Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1067023 | TX |
NPI | 1275001216 |
---|---|
Provider Name | Junefe Asuan Villania |
First Address | Rowlett, TX 75089-8342 |
Second Address | Rockwall, TX 75032-5001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2018 |
Last Update Date | 07/11/2018 |