Provider Demographics
NPI:1245712280
Name:PALESTRO, EDWARD L (DPT)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:L
Last Name:PALESTRO
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 1:1265 BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4004
Mailing Address - Country:US
Mailing Address - Phone:330-758-9400
Mailing Address - Fax:330-726-8676
Practice Address - Street 1:1265 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4004
Practice Address - Country:US
Practice Address - Phone:330-758-9400
Practice Address - Fax:330-726-8676
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist