Provider Demographics
NPI:1225243165
Name:PALLO, TANYA MARIE (MSPT)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:MARIE
Last Name:PALLO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 HIGHLAND AVE
Mailing Address - Street 2:APT. 45
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3662
Mailing Address - Country:US
Mailing Address - Phone:781-635-5313
Mailing Address - Fax:
Practice Address - Street 1:444 WASHINGTON ST
Practice Address - Street 2:SUITE 506
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1046
Practice Address - Country:US
Practice Address - Phone:781-937-9777
Practice Address - Fax:781-937-9767
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15404225100000X
CT006673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist