Provider Demographics
NPI:1588753180
Name:VILLARUEL, MARIE BEATRICE INOCENCIO (PT)
Entity type:Individual
Prefix:
First Name:MARIE BEATRICE
Middle Name:INOCENCIO
Last Name:VILLARUEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 CITRUS TOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6699
Mailing Address - Country:US
Mailing Address - Phone:352-241-4111
Mailing Address - Fax:352-241-4113
Practice Address - Street 1:518 JOHNS LANDING WAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:FL
Practice Address - Zip Code:34787-8984
Practice Address - Country:US
Practice Address - Phone:407-877-3534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 10996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist