Provider Demographics
NPI:1154729937
Name:VILLANUEVA, RECHELLE CRUZ (RPT)
Entity type:Individual
Prefix:MRS
First Name:RECHELLE
Middle Name:CRUZ
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:RECHELLE
Other - Middle Name:ARIAS
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31283 MAPLE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1942
Mailing Address - Country:US
Mailing Address - Phone:248-635-6055
Mailing Address - Fax:
Practice Address - Street 1:31283 MAPLE RIDGE LN
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1942
Practice Address - Country:US
Practice Address - Phone:248-635-6055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019649225100000X
MI5501016241225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist