Individual
RICHARD ILAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
11535 CORTEZ BLVD, BROOKSVILLE, FL 34613-7373
(352) 592-0010
(352) 592-0011
Mailing address
11535 CORTEZ BLVD, BROOKSVILLE, FL 34613-7373
(352) 592-0010
(352) 592-0011
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
PTA25638
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA25638
PT LICENSE
FL
Enumeration date
08/14/2017
Last updated
07/21/2022
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