Provider Demographics
NPI:1215682331
Name:VILLAMATER, REENA (PTA)
Entity type:Individual
Prefix:
First Name:REENA
Middle Name:
Last Name:VILLAMATER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 N WILSON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1141
Mailing Address - Country:US
Mailing Address - Phone:626-848-2147
Mailing Address - Fax:
Practice Address - Street 1:530 N WILSON AVE APT 1
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1141
Practice Address - Country:US
Practice Address - Phone:626-848-2147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51570225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant