Provider Demographics
NPI:1730786369
Name:PALISADES LYMPHEDEMA & ONCOLOGY PHYSIOTHERAPY, RLLP
Entity type:Organization
Organization Name:PALISADES LYMPHEDEMA & ONCOLOGY PHYSIOTHERAPY, RLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:845-325-3271
Mailing Address - Street 1:25 TABLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:TUXEDO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:10987-4721
Mailing Address - Country:US
Mailing Address - Phone:845-325-3271
Mailing Address - Fax:
Practice Address - Street 1:7 NEW LAKE RD
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-1868
Practice Address - Country:US
Practice Address - Phone:845-809-8176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy