Provider Demographics
NPI:1689847816
Name:IGOT, MILADY ORCULLO (PT)
Entity Type:Individual
Prefix:MRS
First Name:MILADY
Middle Name:ORCULLO
Last Name:IGOT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MILADY
Other - Middle Name:
Other - Last Name:ORCULLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:118 BROWN AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-7740
Mailing Address - Country:US
Mailing Address - Phone:931-456-6608
Mailing Address - Fax:931-456-6673
Practice Address - Street 1:118 BROWN AVE STE 104
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-7740
Practice Address - Country:US
Practice Address - Phone:931-456-6608
Practice Address - Fax:931-456-6673
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist