Provider Demographics
NPI:1053298497
Name:ILARDE, RONNEL PENEQUITO (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:RONNEL
Middle Name:PENEQUITO
Last Name:ILARDE
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DR. PAUL TURNER DRIVE
Mailing Address - Street 2:1 DR. PAUL TURNER DRIVE
Mailing Address - City:PAGO PAGO
Mailing Address - State:AMERICAN SAMOA
Mailing Address - Zip Code:96799
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 DR. PAUL TURNER DRIVE
Practice Address - Street 2:1 DR. PAUL TURNER DRIVE
Practice Address - City:PAGO PAGO
Practice Address - State:AMERICAN SAMOA
Practice Address - Zip Code:96799
Practice Address - Country:UM
Practice Address - Phone:684-633-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS5164C225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist