Provider Demographics
NPI:1124314984
Name:CALOPE, MICHELINE ILANO (PT)
Entity type:Individual
Prefix:MISS
First Name:MICHELINE
Middle Name:ILANO
Last Name:CALOPE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 W COMMERCIAL BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3444
Mailing Address - Country:US
Mailing Address - Phone:954-675-7416
Mailing Address - Fax:
Practice Address - Street 1:3278 CORAL RIDGE DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3186
Practice Address - Country:US
Practice Address - Phone:954-675-7416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist