Active NPI
Grace Kelly Villanueva
- Physical Therapist
- Michigan City, IN
National Provider Identifier
1932670064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05008163A
- Practice address
- 3500 Franciscan Way
Michigan City, IN 46360 - Phone
- (219) 877-1613
- NPI assigned
- Dec 16, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05008163A | IN | Primary |
Addresses
Primary practice location
3500 Franciscan Way
Michigan City, IN 46360
Mailing address
PO Box 781076
Detroit, MI 48278-1076
Phone (317) 528-4800
Other practice location 1
301 W Homer St
Michigan City, IN 46360-4358
Phone (219) 877-1613
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1544918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560902400000",
"number": "1932670064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 781076",
"city": "DETROIT",
"state": "MI",
"postal_code": "482781076",
"telephone_number": "317-528-4800",
"fax_number": "317-865-1479"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3500 FRANCISCAN WAY",
"city": "MICHIGAN CITY",
"state": "IN",
"postal_code": "46360",
"telephone_number": "219-877-1613"
}
],
"practiceLocations": [
{
"address_1": "301 W Homer St",
"address_purpose": "LOCATION",
"city": "Michigan City",
"state": "IN",
"postal_code": "463604358",
"country_code": "US",
"telephone_number": "219-877-1613",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VILLANUEVA",
"first_name": "GRACE",
"middle_name": "KELLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-16",
"last_updated": "2019-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05008163A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Michigan City, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.