Provider Demographics
NPI:1760253025
Name:PALLE, CARLO D (PT)
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:D
Last Name:PALLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7406 FEDERLINE LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6442
Mailing Address - Country:US
Mailing Address - Phone:347-458-4155
Mailing Address - Fax:
Practice Address - Street 1:3367 STAGS LEAP DR
Practice Address - Street 2:
Practice Address - City:FINKSBURG
Practice Address - State:MD
Practice Address - Zip Code:21048-2177
Practice Address - Country:US
Practice Address - Phone:443-839-5960
Practice Address - Fax:410-702-7572
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28806261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy