Provider Demographics
NPI:1902492036
Name:ILAGAN, ANGEL MAE TOMBOC (CLT, PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:ANGEL MAE
Middle Name:TOMBOC
Last Name:ILAGAN
Suffix:
Gender:F
Credentials:CLT, PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 SIESTA KEY TRL APT 1213
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-7796
Mailing Address - Country:US
Mailing Address - Phone:561-706-1521
Mailing Address - Fax:
Practice Address - Street 1:743 SIESTA KEY TRL APT 1213
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-7796
Practice Address - Country:US
Practice Address - Phone:561-706-1521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-13
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32718208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty