Provider Demographics
NPI:1760200133
Name:DEPALMA, CARL JR (PT)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:DEPALMA
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 HICKORY HILL DR
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059-9233
Mailing Address - Country:US
Mailing Address - Phone:716-207-6277
Mailing Address - Fax:
Practice Address - Street 1:6055 ARMOR DUELLS RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-3150
Practice Address - Country:US
Practice Address - Phone:716-451-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016325-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist