Provider Demographics
NPI:1699270033
Name:QUILAB, IVOR DINOY
Entity type:Individual
Prefix:
First Name:IVOR
Middle Name:DINOY
Last Name:QUILAB
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 1:4139 DYLAN THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-7148
Mailing Address - Country:US
Mailing Address - Phone:813-407-3662
Mailing Address - Fax:
Practice Address - Street 1:8208 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6679
Practice Address - Country:US
Practice Address - Phone:727-232-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist