Basic Information
| Provider Information | |||||||||
| NPI: | 1225444326 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | VILLAVICENCIO | ||||||||
| FirstName: | APRIL | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11024 BALBOA BLVD. | ||||||||
| Address2: | 504 | ||||||||
| City: | GRANADA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183633000 | ||||||||
| FaxNumber: | 8888332881 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 TERRADO PLAZA | ||||||||
| Address2: | 104 | ||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183633000 | ||||||||
| FaxNumber: | 8888332881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2014 | ||||||||
| LastUpdateDate: | 07/09/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40239-PT | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.