Individual
EUSTAQUIO IBIAS DEVILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Contact information
Practice address
2401 TOMAHAWK MEADOWS DR, MIDLOTHIAN, VA 23112-4290
(757) 589-5264
Mailing address
2401 TOMAHAWK MEADOWS DR, MIDLOTHIAN, VA 23112-4290
(757) 589-5264
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
B1362743
—
225100000X
Physical Therapist
0000004337
TN
225100000X
Physical Therapist
18054
MD
225100000X
Physical Therapist
Primary
2305204220
VA
225100000X
Physical Therapist
2572
SC
Other
Enumeration date
09/25/2007
Last updated
09/25/2007
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