Provider Demographics
NPI:1154747798
Name:DE DIOS, LLONEL LAXAMANA
Entity type:Individual
Prefix:
First Name:LLONEL
Middle Name:LAXAMANA
Last Name:DE DIOS
Suffix:
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 1:44 OLD RIDGEFIELD
Mailing Address - Street 2:ROAD SUITE 213 FOX REHAB CONNECTICUT REGIONAL OFFICE
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44 OLD RIDGEFIELD
Practice Address - Street 2:ROAD SUITE 213 FOX REHAB CONNECTICUT REGIONAL OFFICE
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897
Practice Address - Country:US
Practice Address - Phone:407-681-2999
Practice Address - Fax:407-671-7615
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist