Provider Demographics
NPI:1295035376
Name:PALACAY, NIKKI ZENISA GISALA (PT)
Entity Type:Individual
Prefix:
First Name:NIKKI ZENISA
Middle Name:GISALA
Last Name:PALACAY
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 1:2002 HARRISON ST
Mailing Address - Street 2:APT A
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-4633
Mailing Address - Country:US
Mailing Address - Phone:954-980-7226
Mailing Address - Fax:
Practice Address - Street 1:3101 10TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309-2103
Practice Address - Country:US
Practice Address - Phone:940-766-0281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1199770225100000X
DEJ1-0002565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist