Provider Demographics
NPI:1851440069
Name:PALLOTTA, MICHELE ANN (LAT, ATC, MED,)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ANN
Last Name:PALLOTTA
Suffix:
Gender:F
Credentials:LAT, ATC, MED,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 ADMIRAL DR
Mailing Address - Street 2:420
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2184
Mailing Address - Country:US
Mailing Address - Phone:216-780-7799
Mailing Address - Fax:
Practice Address - Street 1:1521 RITCHIE HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2703
Practice Address - Country:US
Practice Address - Phone:410-544-6038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA002102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer