MEDICARE: IMELDA D PALISOC P.T.

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	1077220	TX

General Provider Information

NPI Number	:	1184964017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMELDA D PALISOC P.T.

Provider Business Mailing Address
First Line	:	612 N RESLER DR STE A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-2370
Country	:	US
Telephone Number	:	915-584-5683
Fax Number	:	915-584-5657

Provider Business Practice Location Address
First Line	:	6559 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-4417
Country	:	US
Telephone Number	:	915-584-5683
Fax Number	:	915-584-5657

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

Provider Enumeration Date	:	03/01/2013
Last Update Date	:	03/11/2025

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