Provider Demographics
NPI:1871177378
Name:REALUBIT, IDYLLA (PT)
Entity type:Individual
Prefix:
First Name:IDYLLA
Middle Name:
Last Name:REALUBIT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 NATALIE WAY
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-1199
Mailing Address - Country:US
Mailing Address - Phone:828-773-2105
Mailing Address - Fax:
Practice Address - Street 1:4949 NATALIE WAY
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-1199
Practice Address - Country:US
Practice Address - Phone:828-773-2105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH72832251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics