Provider Demographics
NPI:1316916364
Name:PALAZZOLO, LISA MARIE (DPT, ATC)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:PALAZZOLO
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:KNAKIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, ATC
Mailing Address - Street 1:236 W WILLOW ST
Mailing Address - Street 2:COACH HOUSE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5769
Mailing Address - Country:US
Mailing Address - Phone:734-330-4486
Mailing Address - Fax:
Practice Address - Street 1:909 DAVIS ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60208-0001
Practice Address - Country:US
Practice Address - Phone:847-733-7906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-0143182251S0007X
IL096-0021042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer