Individual
RENELYN VILLADAREZ VILLANUEVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2100 CANNON DR, MANSFIELD, TX 76063-3476
(817) 779-6500
Mailing address
1500 W LOVERS LN APT 318, ARLINGTON, TX 76013-3721
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
1212275
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1212275
PROFESSIONAL LICENSE NUMBER
TX
Enumeration date
09/07/2018
Last updated
09/07/2018
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