Provider Demographics
NPI:1144613688
Name:PANOPIO, ILYNNE D
Entity Type:Individual
Prefix:
First Name:ILYNNE
Middle Name:D
Last Name:PANOPIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ILYNNE
Other - Middle Name:A
Other - Last Name:DECASTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4406 SLATER AVE
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2753
Mailing Address - Country:US
Mailing Address - Phone:732-809-0008
Mailing Address - Fax:
Practice Address - Street 1:4406 SLATER AVE
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-2753
Practice Address - Country:US
Practice Address - Phone:732-809-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist