Provider Demographics
NPI:1295877603
Name:PALAZZO, JOHN J (DSC,PT,ECS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:PALAZZO
Suffix:
Gender:M
Credentials:DSC,PT,ECS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4385 MOTORWAY DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3451
Mailing Address - Country:US
Mailing Address - Phone:248-342-9907
Mailing Address - Fax:248-681-8571
Practice Address - Street 1:26750 PROVIDENCE PKWY
Practice Address - Street 2:STE. 220
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1211
Practice Address - Country:US
Practice Address - Phone:248-342-9907
Practice Address - Fax:248-681-8571
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12762251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0M25900Medicare PIN