| Doctor Name: | MS. MAIDEN LOUISE AXALAN BACOLOD |
| NPI Number: | 1306093661 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | 070016218 |
| Business Practice Address: | 900 S Chestnut Prairie Rose Healthcare Center Pana, IL - 62557 |
| Business Phone Number: | 2175623996 |
| Business Fax Number: | |
| Mailing Address: | 306 W 7th St, Apt 6 PANA |
| State: | IL |
| Postal Code: | 625571569 |
| Phone Number: | 7089906217 |
| Fax Number: | |
| NPI Enumeration Date: | 08/19/2008 |
| NPI Last Update Date: | 08/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 070016218 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |