Provider Demographics
NPI:1811142912
Name:ILALIO, THERESE D (LPTA)
Entity type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:D
Last Name:ILALIO
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 INDEPENDENCE DRIVE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-4600
Mailing Address - Country:US
Mailing Address - Phone:907-522-1341
Mailing Address - Fax:907-522-1343
Practice Address - Street 1:9500 INDEPENDENCE DRIVE
Practice Address - Street 2:SUITE 900
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4600
Practice Address - Country:US
Practice Address - Phone:907-522-1341
Practice Address - Fax:907-522-1343
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist