Provider Demographics
NPI:1770796351
Name:PALLIS, KRISTIN (PT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:PALLIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 BROADWAY
Mailing Address - Street 2:PARTNERS IN REHAB
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906
Mailing Address - Country:US
Mailing Address - Phone:781-233-2111
Mailing Address - Fax:781-233-2122
Practice Address - Street 1:880 BROADWAY
Practice Address - Street 2:PARTNERS IN REHAB
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906
Practice Address - Country:US
Practice Address - Phone:781-233-2111
Practice Address - Fax:781-233-2122
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153932251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA15393OtherPHYSICAL THERAPY LIC
MA15393OtherPHYSICAL THERAPY LIC