Provider Demographics
NPI:1144354168
Name:PANLILIO, NICCOLO MARIANO (RPT)
Entity type:Individual
Prefix:MR
First Name:NICCOLO
Middle Name:MARIANO
Last Name:PANLILIO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 RULEME ST APT 46
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6512
Mailing Address - Country:US
Mailing Address - Phone:352-217-6990
Mailing Address - Fax:
Practice Address - Street 1:2800 RULEME ST APT 46
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6512
Practice Address - Country:US
Practice Address - Phone:352-217-6990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist