Basic Information
Provider Information
NPI: 1407872450
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PALLESCHI
FirstName: KARA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 63 S MAIN ST
Address2:  
City: RANDOLPH
State: MA
PostalCode: 023684820
CountryCode: US
TelephoneNumber: 7819619200
FaxNumber: 7819616599
Practice Location
Address1: 75 FINNELL DR
Address2:  
City: WEYMOUTH
State: MA
PostalCode: 021881110
CountryCode: US
TelephoneNumber: 7813351151
FaxNumber: 7813357851
Other Information
ProviderEnumerationDate: 07/14/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X16621MAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


Home