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General NPI Number Information
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NPI Number | 1629195391
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Entity Type | Organization
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Legal Business Name | PALISADES PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 1 SCOTTI AVE
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City | PALISADES
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State | NY
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Zip | 10964-1319
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Country | US
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Telephone | 845-359-3950
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Fax | 845-359-3950
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Provider Business Mailing Address
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Address Line | 1 SCOTTI AVE
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City | PALISADES
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State | NY
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Zip | 10964-1319
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Country | US
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Telephone | 845-359-3950
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Fax | 845-359-3950
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DR. EDMUND P KALOTKIN
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Credential | DPT
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Telephone | 845-359-3950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 24559
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License Number State | NY
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