Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 4612 | OR |
NPI | 1053449892 |
---|---|
Provider Name | Mr. Thomas J. Palermo |
First Address | Mercer Island, WA 98040-4933 |
Second Address | Bellevue, WA 98004-1432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 08/05/2013 |