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NPI Code Detail

MEDICARE: MIRIAM MORALES OCILLOS P.T.

MEDICARE: MIRIAM MORALES OCILLOS P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist070.014789IL

General Provider Information

NPI Number : 1356483952
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRIAM MORALES OCILLOS P.T.
Provider Business Mailing Address
First Line : 1401 E STATE ST
Second Line :
City : ROCKFORD
State : IL
Zip : 61104-2315
Country : US
Telephone Number : 815-968-4400
Fax Number :
Provider Business Practice Location Address
First Line : 1301 N ALPINE RD # 201
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-2262
Country : US
Telephone Number : 779-696-0700
Fax Number : 779-696-0710
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2007
Last Update Date : 04/18/2024

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Directions to “ MIRIAM MORALES OCILLOS P.T.” Practice Location

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