MAYNARD VILLAVICENCIO UTAYDE

MISHAWAKA, IN
NPI1699832113
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy225100000X Physical Therapist
(Licence: IN  05005198A)
Enumeration Date2007-01-03
Last Update Date2016-07-17
Business Address
Mr. MAYNARD VILLAVICENCIO UTAYDE PT
1409 E DAY RD
MISHAWAKA, IN 46545-3671
Phone number: 574-257-9880
Mailing Address
Mr. MAYNARD VILLAVICENCIO UTAYDE PT
51470 NORWICH DR
GRANGER, IN 46530-8426
Phone number: 574-257-9880
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