Provider Demographics
NPI:1013179175
Name:ILER, DAVID A JR (LMT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:ILER
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 W SARAH ST APT 30
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3853
Mailing Address - Country:US
Mailing Address - Phone:818-967-6618
Mailing Address - Fax:
Practice Address - Street 1:4240 W SARAH ST APT 30
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-3853
Practice Address - Country:US
Practice Address - Phone:818-967-6618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist