MEDICARE: LISA MARIE PALKO

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	225100000X	Physical Therapist	PT031846	PA

General Provider Information

NPI Number	:	1023882289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE PALKO

Provider Business Mailing Address
First Line	:	3020 BAIR RD
Second Line	:
City	:	LOWER BURRELL
State	:	PA
Zip	:	15068-8705
Country	:	US
Telephone Number	:	724-594-4733
Fax Number	:

Provider Business Practice Location Address
First Line	:	2279 MAIN ST # B
Second Line	:
City	:	HOMESTEAD
State	:	PA
Zip	:	15120-2652
Country	:	US
Telephone Number	:	724-594-4733
Fax Number	:

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

Provider Enumeration Date	:	11/08/2023
Last Update Date	:	11/08/2023

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Directions to “ LISA MARIE PALKO ” Practice Location

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