Provider Demographics
NPI:1679842413
Name:PALAZZI, JEANINE RENEE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JEANINE
Middle Name:RENEE
Last Name:PALAZZI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:JEANINE
Other - Middle Name:RENEE
Other - Last Name:COLENBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1736 MADISON 2810
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72740
Mailing Address - Country:US
Mailing Address - Phone:479-665-2659
Mailing Address - Fax:
Practice Address - Street 1:1736 MADISON 2810
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72740-8730
Practice Address - Country:US
Practice Address - Phone:123-456-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 2488225200000X
FLPTA 22904225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant