Basic Information
| Provider Information | |||||||||
| NPI: | 1679508279 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ILAGAN | ||||||||
| FirstName: | OLGA | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4600 N RUSHMORE LOOP | ||||||||
| Address2: | |||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344653125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3528175162 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3470 N LECANTO HWY | ||||||||
| Address2: | |||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344653548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527469500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 06/02/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT5465 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.