Provider Demographics
NPI:1265458194
Name:PALKO, ANITA (PT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:PALKO
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 1:2520 GOODWATER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1514
Mailing Address - Country:US
Mailing Address - Phone:530-224-3322
Mailing Address - Fax:530-224-3325
Practice Address - Street 1:320 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1846
Practice Address - Country:US
Practice Address - Phone:530-226-9242
Practice Address - Fax:530-226-9070
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18605225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ23129ZOtherMEDICARE GROUP
CA0PT186050Medicare ID - Type Unspecified
0PT186050Medicare PIN