Basic Information
| Provider Information | |||||||||
| NPI: | 1770893174 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PALUSO | ||||||||
| FirstName: | DOMINICK | ||||||||
| MiddleName: | VINCENT | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 709 S HARBOR CITY BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329011938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218025810 | ||||||||
| FaxNumber: | 3218025811 | ||||||||
| Practice Location | |||||||||
| Address1: | 709 S HARBOR CITY BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329011938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218025810 | ||||||||
| FaxNumber: | 3218025811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2010 | ||||||||
| LastUpdateDate: | 06/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT27982 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.