Provider Demographics
NPI:1215129101
Name:VILLALON, VALORA MAE (LMT)
Entity type:Individual
Prefix:
First Name:VALORA
Middle Name:MAE
Last Name:VILLALON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 SE 4TH AVE
Mailing Address - Street 2:STE G
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4033
Mailing Address - Country:US
Mailing Address - Phone:503-681-9673
Mailing Address - Fax:503-844-4093
Practice Address - Street 1:245 SE 4TH AVE
Practice Address - Street 2:STE G
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4033
Practice Address - Country:US
Practice Address - Phone:503-681-9673
Practice Address - Fax:503-844-4093
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11065225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist