MEDICARE: MRS. JEANINE RENEE PALAZZI PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA 2488	AR
2	225200000X	Physical Therapy Assistant	PTA 22904	FL

General Provider Information

NPI Number	:	1679842413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEANINE RENEE PALAZZI PTA

Provider Business Mailing Address
First Line	:	1736 MADISON 2810
Second Line	:
City	:	HUNTSVILLE
State	:	AR
Zip	:	72740
Country	:	US
Telephone Number	:	479-665-2659
Fax Number	:

Provider Business Practice Location Address
First Line	:	1736 MADISON 2810
Second Line	:
City	:	HUNTSVILLE
State	:	AR
Zip	:	72740-8730
Country	:	US
Telephone Number	:	123-456-7890
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2011
Last Update Date	:	12/23/2011

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