Provider Demographics
NPI:1285609362
Name:VILLARREAL, KATHRYN E (MSPT)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:E
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8076 WINDWARD KEY DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-3185
Mailing Address - Country:US
Mailing Address - Phone:109-344-0284
Mailing Address - Fax:410-609-9968
Practice Address - Street 1:8076 WINDWARD KEY DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE BEACH
Practice Address - State:MD
Practice Address - Zip Code:20732-3185
Practice Address - Country:US
Practice Address - Phone:410-934-4028
Practice Address - Fax:410-609-9968
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29259208100000X
PAPT0172532251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation