Most Relevant Information
Provider Data
| NPI Number: | 1003524554 |
| Provider Name: | ELISSA MORALES-VILLANUEVA MAT, ATC |
| Entity Type: | Individual |
| Taxonomy Code: | 2255A2300X |
| Specialty: | Specialist/Technologist |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/14/2022 |
| Last Updated: | 10/04/2023 |
Provider Practice Location
5620 SPRING CREEK RD
ROCKFORD
IL
611146442
Practice Location Phone/Fax
| Phone: | 8156544870 |
| Fax: |
Provider Mailing Location
2005 GRENSHAW ST
ROCKFORD
IL
611014234
Provider Mailing Phone/Fax
| Phone: | 8156683544 |
| Fax: |