Provider Demographics
NPI:1093764094
Name:PALU, MARIE LOUISE (PT)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:LOUISE
Last Name:PALU
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:PO BOX 4386
Mailing Address - Street 2:
Mailing Address - City:INCLINE VILLAGE
Mailing Address - State:NV
Mailing Address - Zip Code:89450-4386
Mailing Address - Country:US
Mailing Address - Phone:775-833-1900
Mailing Address - Fax:775-833-0889
Practice Address - Street 1:797 SOUTHWOOD BLVD
Practice Address - Street 2:# 3
Practice Address - City:INCLINE VILLAGE
Practice Address - State:NV
Practice Address - Zip Code:89451-9484
Practice Address - Country:US
Practice Address - Phone:775-833-1900
Practice Address - Fax:775-833-0889
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV33988Medicare UPIN