Active NPI
Eldie Mangubat Ilano, P.T.
- Geriatric Physical Therapist
- Canton, MI
National Provider Identifier
1629547823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- 5501003902
- Practice address
- 7025 N Lilley Rd
Canton, MI 48187-3533 - Phone
- (734) 394-3100
- NPI assigned
- Nov 16, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | 5501003902 | MI | Primary |
Addresses
Primary practice location
7025 N Lilley Rd
Canton, MI 48187-3533
Mailing address
7025 N Lilley Rd
Canton, MI 48187-3533
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501003902 | MI | MD | Geriatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542326400000",
"number": "1629547823",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7025 N LILLEY RD",
"city": "CANTON",
"state": "MI",
"postal_code": "481873533"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7025 N LILLEY RD",
"city": "CANTON",
"state": "MI",
"postal_code": "481873533",
"telephone_number": "734-394-3100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILANO",
"first_name": "ELDIE",
"middle_name": "MANGUBAT",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-11-16",
"last_updated": "2018-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "MI",
"license": "5501003902",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.