Provider Demographics
NPI:1659106607
Name:VILARDO, ANNALYN BANTUGAN (PT, DPT, CLWT, GCS)
Entity type:Individual
Prefix:
First Name:ANNALYN
Middle Name:BANTUGAN
Last Name:VILARDO
Suffix:
Gender:F
Credentials:PT, DPT, CLWT, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MOUNT HOPE AVE
Mailing Address - Street 2:
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-1109
Mailing Address - Country:US
Mailing Address - Phone:518-586-0981
Mailing Address - Fax:
Practice Address - Street 1:45 MONTCALM ST
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-1343
Practice Address - Country:US
Practice Address - Phone:518-585-6230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist