Provider Demographics
NPI:1417569377
Name:ILAGAN, IRENE PAULINE PADILLA (DPT)
Entity Type:Individual
Prefix:
First Name:IRENE PAULINE
Middle Name:PADILLA
Last Name:ILAGAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 65TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-5758
Mailing Address - Country:US
Mailing Address - Phone:929-253-2418
Mailing Address - Fax:
Practice Address - Street 1:4413 65TH ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5758
Practice Address - Country:US
Practice Address - Phone:929-253-2418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist