MEDICARE: OLGA A ILAGAN

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	PT5465	FL

General Provider Information

NPI Number	:	1679508279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLGA A ILAGAN

Provider Business Mailing Address
First Line	:	4600 N RUSHMORE LOOP
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-3125
Country	:	US
Telephone Number	:	352-817-5162
Fax Number	:

Provider Business Practice Location Address
First Line	:	3470 N LECANTO HWY
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-3548
Country	:	US
Telephone Number	:	352-746-9500
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	06/02/2016

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Directions to “ OLGA A ILAGAN ” Practice Location

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