Individual
DANA RENEE ILLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1150 COLONY DR, WESTERVILLE, OH 43081-3624
(614) 891-5055
Mailing address
3998 TRADE ROYAL XING, COLUMBUS, OH 43230-6464
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A4799
MD
Other
Enumeration date
01/07/2019
Last updated
01/10/2022
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