Mark Joseph Villanueva Gamboa

NPI #1619374980 in St Johnsville, New York

Provider Information

NPI Number: 1619374980
Entity Type: Individual
Name: Mark Joseph Villanueva Gamboa
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapist
Enumeration Date: Dec 2, 2014
Last Updated: Jun 15, 2017

Practice Location

Address: 7 TIMMERMAN AVE
City: St Johnsville
State: New York
ZIP Code: 13452-1017
Phone: (518) 568-5037

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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