Provider Demographics
NPI:1982748364
Name:PALMISANO, HOLLIE LEAH (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:LEAH
Last Name:PALMISANO
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BISHOP PL
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1178
Mailing Address - Country:US
Mailing Address - Phone:848-932-7402
Mailing Address - Fax:
Practice Address - Street 1:11 BISHOP PL
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1178
Practice Address - Country:US
Practice Address - Phone:848-932-7402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001303002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer