Provider Demographics
NPI:1427570688
Name:RALLO, LYDIA R (DPT)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:R
Last Name:RALLO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 52ND ST STE 240
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-3423
Mailing Address - Country:US
Mailing Address - Phone:262-925-2190
Mailing Address - Fax:262-925-5000
Practice Address - Street 1:23 TURTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3152
Practice Address - Country:US
Practice Address - Phone:828-274-2188
Practice Address - Fax:828-274-7843
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP17654225100000X
WI13862-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist