Basic Information
| Provider Information | |||||||||
| NPI: | 1003165853 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PALIWODA | ||||||||
| FirstName: | ALYSON | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 BRADSTREET AVE | ||||||||
| Address2: | |||||||||
| City: | THOMASTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067871505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176505160 | ||||||||
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| Practice Location | |||||||||
| Address1: | 117 SHARON RD | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067054000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037562334 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2012 | ||||||||
| LastUpdateDate: | 01/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 20208 | MA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 225100000X | 010015 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.