Provider Demographics
NPI:1871796698
Name:VILLANUEVA, ZEUS TADIJE (PT)
Entity type:Individual
Prefix:MR
First Name:ZEUS
Middle Name:TADIJE
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E VERNON AVE APT E8
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-3816
Mailing Address - Country:US
Mailing Address - Phone:309-319-1416
Mailing Address - Fax:
Practice Address - Street 1:510 BROADWAY ST. , MANOR CARE REHAB AND NURSING
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61716-3816
Practice Address - Country:US
Practice Address - Phone:309-452-4406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist