Provider Demographics
NPI:1467652958
Name:PALLADINO, BETH DANIELLE (RPT)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:DANIELLE
Last Name:PALLADINO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3121
Mailing Address - Country:US
Mailing Address - Phone:860-621-4380
Mailing Address - Fax:860-620-0270
Practice Address - Street 1:18 S CENTER ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-3121
Practice Address - Country:US
Practice Address - Phone:860-621-4380
Practice Address - Fax:860-620-0270
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist