Icelle Grace Villanueva Martinez, PT, DPT
Physical Medicine & Rehabilitation in Livonia, MI. Individual provider (NPI-1).
NPI number1508423138
StatusActive
Last updated in NPPESMay 20, 2019
Details
- NPI
- 1508423138
- Entity type
- Individual (NPI-1)
- Name
- Icelle Grace Villanueva Martinez
- Credential
- PT, DPT
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- May 20, 2019
- Last updated
- May 20, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208100000X | Physical Medicine & Rehabilitation | 5501012216 | MI | Yes |
Practice location
36313 St Andrews DrLivonia, MI 48152-4130
Phone 248-805-2622
Mailing address
36313 St Andrews DrLivonia, MI 48152-4130
Phone 248-805-2622
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