Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 61133 | OR |
NPI | 1033595129 |
---|---|
Provider Name | Dr. Derek Lee Palmer |
First Address | Salem, OR 97301-4741 |
Second Address | Salem, OR 97306-9675 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2015 |
Last Update Date | 05/08/2015 |