Provider Demographics
NPI:1982114583
Name:MILO, IMELDA DAYUTA (PT)
Entity Type:Individual
Prefix:
First Name:IMELDA
Middle Name:DAYUTA
Last Name:MILO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:993 CEDAR CLIFF CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-9736
Mailing Address - Country:US
Mailing Address - Phone:559-930-9670
Mailing Address - Fax:
Practice Address - Street 1:136 DOCKSIDE BAY
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-2704
Practice Address - Country:US
Practice Address - Phone:559-930-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26408225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT26408OtherCA PT LICENSE