Provider Demographics
NPI:1356093728
Name:PALKA, ELIZABETH (MT, NMT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:PALKA
Suffix:
Gender:F
Credentials:MT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 W UINTAH ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2958
Mailing Address - Country:US
Mailing Address - Phone:719-247-8441
Mailing Address - Fax:
Practice Address - Street 1:1712 W UINTAH ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-2958
Practice Address - Country:US
Practice Address - Phone:719-247-8441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.002587225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist