Healthcare Provider Details

I. General information

NPI: 1417136417
Provider Name (Legal Business Name): KEVIN PALLONE MPT PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10151 ENTERPRISE CTR SUITE 107
BOYNTON BEACH FL
33437-3759
US

IV. Provider business mailing address

10151 ENTERPRISE CTR SUITE 107
BOYNTON BEACH FL
33437-3759
US

V. Phone/Fax

Practice location:
  • Phone: 561-859-6711
  • Fax: 888-737-0680
Mailing address:
  • Phone: 561-859-6711
  • Fax: 888-737-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KEVIN G PALLONE
Title or Position: PRESIDENT
Credential:
Phone: 561-859-6711