Provider Demographics
NPI:1548667520
Name:PABLO, LEONILO JR
Entity type:Individual
Prefix:
First Name:LEONILO
Middle Name:
Last Name:PABLO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12357 HOLLOW GLADE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-4205
Mailing Address - Country:US
Mailing Address - Phone:904-269-2437
Mailing Address - Fax:904-264-2330
Practice Address - Street 1:1218 PARK AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4152
Practice Address - Country:US
Practice Address - Phone:904-269-2437
Practice Address - Fax:904-264-2330
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT29880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist