Provider Demographics
NPI:1376661611
Name:HENRY PALLOTTA & CARAMIA PALLOTTA, PTRS
Entity Type:Organization
Organization Name:HENRY PALLOTTA & CARAMIA PALLOTTA, PTRS
Other - Org Name:MANTECA PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNERSHIP
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PALLOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:209-239-4325
Mailing Address - Street 1:1041 N MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-3744
Mailing Address - Country:US
Mailing Address - Phone:209-239-4325
Mailing Address - Fax:209-239-2320
Practice Address - Street 1:1041 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-3744
Practice Address - Country:US
Practice Address - Phone:209-239-4325
Practice Address - Fax:209-239-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0700000325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171414000OtherOWCP
CA171414000OtherOWCP