Basic Information
| Provider Information | |||||||||
| NPI: | 1801319132 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VILLECCO | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | LOUIS | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4801 HARGROVE RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276161949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197916260 | ||||||||
| FaxNumber: | 9199819213 | ||||||||
| Practice Location | |||||||||
| Address1: | 1541 WESTBROOK PLAZA DR | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271031329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367654703 | ||||||||
| FaxNumber: | 3367651396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2017 | ||||||||
| LastUpdateDate: | 03/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.