Provider Demographics
NPI:1790460400
Name:PALACIO, POCHOLO LAWSIN (PT)
Entity Type:Individual
Prefix:
First Name:POCHOLO
Middle Name:LAWSIN
Last Name:PALACIO
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 1:202 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4312
Mailing Address - Country:US
Mailing Address - Phone:864-497-7749
Mailing Address - Fax:
Practice Address - Street 1:190 RIVER PARK DR
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-6844
Practice Address - Country:US
Practice Address - Phone:843-741-0082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist