Individual
MR. CARLOS VILLAVERDE AVILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S.P.T.
Contact information
Practice address
5 CAMDEN CT, MEDFORD, NY 11763-1583
(631) 736-4334
(631) 736-4333
Mailing address
5 CAMDEN CT, MEDFORD, NY 11763-1583
(631) 736-4334
(631) 736-4333
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
023135-1
NY
Other
Enumeration date
11/18/2008
Last updated
11/18/2008
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