Provider Demographics
NPI:1124100904
Name:ILORI, JANICE DK
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:DK
Last Name:ILORI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:DELORIS
Other - Last Name:KINLAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1225 MCALLISTAR DR
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-2467
Mailing Address - Country:US
Mailing Address - Phone:678-432-2044
Mailing Address - Fax:
Practice Address - Street 1:1225 MCALLISTAR DR
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-2467
Practice Address - Country:US
Practice Address - Phone:678-432-2044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist