Provider Demographics
NPI:1760987309
Name:PALISOC, GABRIEL URIEL ESCALONA (DPT)
Entity Type:Individual
Prefix:
First Name:GABRIEL URIEL
Middle Name:ESCALONA
Last Name:PALISOC
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 GRANDHAVEN AVE UPPR MARLBORO
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-5247
Mailing Address - Country:US
Mailing Address - Phone:240-714-6007
Mailing Address - Fax:
Practice Address - Street 1:9401 GRANDHAVEN AVE UPPR MARLBORO
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-5247
Practice Address - Country:US
Practice Address - Phone:240-714-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist