Provider Demographics
NPI:1104410489
Name:PALAO, RODELIO U
Entity type:Individual
Prefix:
First Name:RODELIO
Middle Name:U
Last Name:PALAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2249 APACHE DR APT 4
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-1970
Mailing Address - Country:US
Mailing Address - Phone:786-252-8250
Mailing Address - Fax:
Practice Address - Street 1:12803 LENOVER ST
Practice Address - Street 2:
Practice Address - City:DILLSBORO
Practice Address - State:IN
Practice Address - Zip Code:47018-9418
Practice Address - Country:US
Practice Address - Phone:812-432-5226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013957A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist