Provider Demographics
NPI:1558693705
Name:ILAGAN, CHLOTILE C (PT)
Entity Type:Individual
Prefix:
First Name:CHLOTILE
Middle Name:C
Last Name:ILAGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHLOTILE
Other - Middle Name:O
Other - Last Name:CARREON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1100 JOLIET ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1996
Mailing Address - Country:US
Mailing Address - Phone:219-864-3300
Mailing Address - Fax:219-864-2569
Practice Address - Street 1:7435 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-2909
Practice Address - Country:US
Practice Address - Phone:219-844-8100
Practice Address - Fax:219-844-7460
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010173A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist