Provider Demographics
NPI:1679063028
Name:PALATUCCI, DEANNA NICOLE
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:NICOLE
Last Name:PALATUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 DAVIS ST STE B
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7009
Mailing Address - Country:US
Mailing Address - Phone:540-685-0168
Mailing Address - Fax:
Practice Address - Street 1:300 PELL AVE STE B
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1182
Practice Address - Country:US
Practice Address - Phone:540-484-1456
Practice Address - Fax:540-484-1236
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty