Provider Demographics
NPI:1609047463
Name:PALLOTTA, CARAMIA BIANCA (PT)
Entity Type:Individual
Prefix:
First Name:CARAMIA
Middle Name:BIANCA
Last Name:PALLOTTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 N MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-3988
Mailing Address - Country:US
Mailing Address - Phone:209-239-4325
Mailing Address - Fax:209-239-2320
Practice Address - Street 1:1041 N MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-3988
Practice Address - Country:US
Practice Address - Phone:209-239-4325
Practice Address - Fax:209-239-2320
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 15441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist