Provider Demographics
NPI:1386187789
Name:PALERMO, SALVATORE MICHAEL (DAT, LAT, ATC, CES)
Entity Type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:MICHAEL
Last Name:PALERMO
Suffix:
Gender:M
Credentials:DAT, LAT, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CHARTER ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-5077
Mailing Address - Country:US
Mailing Address - Phone:401-481-5035
Mailing Address - Fax:
Practice Address - Street 1:300 AVENGER DR
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-2217
Practice Address - Country:US
Practice Address - Phone:401-481-5035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30202255A2300X
RIAT004582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer