Basic Information
| Provider Information | |||||||||
| NPI: | 1871963645 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | VILLEGAS | ||||||||
| FirstName: | JENNY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1219 MILLENNIUM PKWY STE 104 | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335113891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136554166 | ||||||||
| FaxNumber: | 8136554814 | ||||||||
| Practice Location | |||||||||
| Address1: | 1219 MILLENNIUM PKWY STE 104 | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335113891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136554166 | ||||||||
| FaxNumber: | 8136554814 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2015 | ||||||||
| LastUpdateDate: | 10/05/2015 | ||||||||
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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 | 222Q00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist |
No ID Information.