Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 11294 | MN |
N | 2251S0007X | Physical Therapist - Sports | PT-5264 | ID |
NPI | 1093231714 |
---|---|
Provider Name | James Palmer |
First Address | Golden Valley, MN 55422-4841 |
Second Address | Edina, MN 55435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2017 |
Last Update Date | 27/09/2018 |