Provider Demographics
NPI:1730520826
Name:PALUMBO, JUSTIN M (PT)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:M
Last Name:PALUMBO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 W CALLE MANTILLA
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-6636
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:74 W CALLE MANTILLA
Practice Address - Street 2:ENTER YOUR SECOND ADDRESS
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-6636
Practice Address - Country:US
Practice Address - Phone:608-609-1036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12345-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist