Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 020083-1 | NY |
NPI | 1003040536 |
---|---|
Provider Name | Olga L. Villamil |
First Address | Bronx, NY 10461-6265 |
Second Address | Bronx, NY 10461-6265 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2009 |
Last Update Date | 12/05/2009 |