Provider Demographics
NPI:1386179851
Name:PAGLINAWAN, PATCHOLO YAP (PT)
Entity Type:Individual
Prefix:
First Name:PATCHOLO
Middle Name:YAP
Last Name:PAGLINAWAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 VALLEY FORGE RD
Mailing Address - Street 2:APARTMENT A
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6929
Mailing Address - Country:US
Mailing Address - Phone:618-316-1299
Mailing Address - Fax:
Practice Address - Street 1:1310 MARK FRANKLIN DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812-2049
Practice Address - Country:US
Practice Address - Phone:618-439-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070021988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist