MEDICARE: CHLOTILE C ILAGAN PT

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
1	225100000X	Physical Therapist	05010173A	IN

General Provider Information

NPI Number	:	1558693705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHLOTILE C ILAGAN PT

Provider Business Mailing Address
First Line	:	1100 JOLIET ST
Second Line	:	SUITE 205
City	:	DYER
State	:	IN
Zip	:	46311-1996
Country	:	US
Telephone Number	:	219-864-3300
Fax Number	:	219-864-2569

Provider Business Practice Location Address
First Line	:	7435 INDIANAPOLIS BLVD
Second Line	:
City	:	HAMMOND
State	:	IN
Zip	:	46324-2909
Country	:	US
Telephone Number	:	219-844-8100
Fax Number	:	219-844-7460

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2010
Last Update Date	:	02/12/2010

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Directions to “ CHLOTILE C ILAGAN PT” Practice Location

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