Provider Demographics
NPI:1881768356
Name:CALDERON, AILEEN O (RPT)
Entity type:Individual
Prefix:MRS
First Name:AILEEN
Middle Name:O
Last Name:CALDERON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MS
Other - First Name:AILEEN
Other - Middle Name:M
Other - Last Name:ONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:6 GLADSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-4766
Mailing Address - Country:US
Mailing Address - Phone:864-908-4482
Mailing Address - Fax:
Practice Address - Street 1:35 SOUTHPOINTE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5956
Practice Address - Country:US
Practice Address - Phone:864-288-1415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist