Individual
ALEXIS TONI VILLANUEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
401 N FAIRVIEW ST, HEALTH PROFESSIONS BUILDING, LOCK HAVEN, PA 17745-2342
(570) 484-2878
(750) 484-2200
Mailing address
401 N FAIRVIEW ST, HEALTH PROFESSIONS BUILDING, LOCK HAVEN, PA 17745-2342
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT005066
PA
Other
Enumeration date
12/14/2011
Last updated
12/14/2011
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