Individual
MR. WIRT RAINIER VILLANUEVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Contact information
Practice address
75 OLD TOMS RIVER RD, BRICK, NJ 08723-7800
(732) 451-1000
Mailing address
12 ETTY CT, MANCHESTER, NJ 08759-5918
(732) 323-8628
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
40QA01009100
NJ
Other
Enumeration date
09/14/2007
Last updated
09/14/2007
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