Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT23634 | FL |
NPI | 1073702791 |
---|---|
Provider Name | Mr. Jose Daniel Villasana |
First Address | South Daytona, FL 32119-3475 |
Second Address | South Daytona, FL 32119-3475 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2007 |
Last Update Date | 18/10/2007 |