Provider Demographics
NPI:1497965867
Name:PADILLO, JAY LOMIBAO (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:LOMIBAO
Last Name:PADILLO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1254 N EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1429
Mailing Address - Country:US
Mailing Address - Phone:818-245-0210
Mailing Address - Fax:818-827-3350
Practice Address - Street 1:409 S LA BREA AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-2321
Practice Address - Country:US
Practice Address - Phone:818-245-0210
Practice Address - Fax:818-827-3350
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist