Provider Demographics
NPI:1801268461
Name:HORMILLOSA, OSCAR JEROME III (PT)
Entity type:Individual
Prefix:
First Name:OSCAR JEROME III
Middle Name:
Last Name:HORMILLOSA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 E SPRINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4448
Mailing Address - Country:US
Mailing Address - Phone:812-232-3504
Mailing Address - Fax:812-232-6396
Practice Address - Street 1:15 FOREST PARK PLZ
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2737
Practice Address - Country:US
Practice Address - Phone:812-420-1114
Practice Address - Fax:812-420-1115
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036237225100000X
IN05011813A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist