Provider Demographics
NPI:1710378922
Name:QUILANG, VIDELIA (PT)
Entity Type:Individual
Prefix:
First Name:VIDELIA
Middle Name:
Last Name:QUILANG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9143 PHILIPS HWY
Mailing Address - Street 2:SUITE 170
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-1348
Mailing Address - Country:US
Mailing Address - Phone:904-353-2019
Mailing Address - Fax:
Practice Address - Street 1:9143 PHILIPS HWY
Practice Address - Street 2:SUITE 170
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1348
Practice Address - Country:US
Practice Address - Phone:904-353-2019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 9277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist