Basic Information
| Provider Information | |||||||||
| NPI: | 1699270033 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUILAB | ||||||||
| FirstName: | IVOR | ||||||||
| MiddleName: | DINOY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4139 DYLAN THOMAS DR | ||||||||
| Address2: | |||||||||
| City: | WESLEY CHAPEL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335437148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134073662 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8208 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346686679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272327000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2018 | ||||||||
| LastUpdateDate: | 03/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT22252 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.