Provider Demographics
NPI:1437772357
Name:PALAKEEL, MARINA
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:PALAKEEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5131 FOOTHILLS BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-6527
Mailing Address - Country:US
Mailing Address - Phone:916-797-2273
Mailing Address - Fax:
Practice Address - Street 1:5131 FOOTHILLS BLVD STE 5
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-6527
Practice Address - Country:US
Practice Address - Phone:916-797-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302865225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist