MEDICARE: CARISSA MONIQUE PALACIOS PT, DPT

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	1408299	TX

General Provider Information

NPI Number	:	1861325227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARISSA MONIQUE PALACIOS PT, DPT

Provider Business Mailing Address
First Line	:	1726 BRAESWOOD DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78412-4584
Country	:	US
Telephone Number	:	361-500-6686
Fax Number	:	361-299-5882

Provider Business Practice Location Address
First Line	:	1114 N 14TH ST
Second Line	:
City	:	KINGSVILLE
State	:	TX
Zip	:	78363-4069
Country	:	US
Telephone Number	:	361-500-6686
Fax Number	:	361-299-5882

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

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/06/2026

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