Provider Demographics
NPI:1902146830
Name:PALISOC, VITUS D (PT)
Entity type:Individual
Prefix:
First Name:VITUS
Middle Name:D
Last Name:PALISOC
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 1:612 N RESLER DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2369
Mailing Address - Country:US
Mailing Address - Phone:915-584-5683
Mailing Address - Fax:915-584-5657
Practice Address - Street 1:612 N RESLER DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-2369
Practice Address - Country:US
Practice Address - Phone:915-584-5683
Practice Address - Fax:915-584-5657
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1075083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist