Provider Demographics
NPI:1821728817
Name:PALAD, MIKO EMMANUEL PERALTA (DPT)
Entity Type:Individual
Prefix:DR
First Name:MIKO EMMANUEL
Middle Name:PERALTA
Last Name:PALAD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 SOUTHGATE DR APT 7H
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-7203
Mailing Address - Country:US
Mailing Address - Phone:618-315-8730
Mailing Address - Fax:
Practice Address - Street 1:1021 SOUTHGATE DR APT 7H
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-7203
Practice Address - Country:US
Practice Address - Phone:618-315-8730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.022577225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist