Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070016826 | IL |
NPI | 1003055765 |
---|---|
Provider Name | Mr. Rojie M Palatolon |
First Address | Sterling, IL 61081-1085 |
Second Address | Sterling, IL 61081-1085 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2009 |
Last Update Date | 19/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09821954 | BCBS (01) | IL |