Provider Demographics
NPI:1780807933
Name:PALILLO, STEFANIE MARIE (MPT)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:MARIE
Last Name:PALILLO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:MARIE
Other - Last Name:YULE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:423 SCRANTON CARBONDALE HWY
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-1115
Mailing Address - Country:US
Mailing Address - Phone:570-207-5502
Mailing Address - Fax:570-207-5511
Practice Address - Street 1:423 SCRANTON CARBONDALE HWY
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1115
Practice Address - Country:US
Practice Address - Phone:570-207-5502
Practice Address - Fax:570-207-5511
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01241100225100000X
NY030914225100000X
PAPT020440225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2510492OtherBC/BS
PA102584725Medicaid
PA102584725Medicaid