Provider Demographics
NPI:1144330895
Name:VILLARREAL, VICKY (MPT)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:
Other - Last Name:KHANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:21938 ROYAL MONTREAL DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5142
Practice Address - Country:US
Practice Address - Phone:281-944-0001
Practice Address - Fax:844-671-0027
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07165R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist