Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 9496 | MN |
NPI | 1093309957 |
---|---|
Provider Name | Mrs. Jessica Palmer |
First Address | Rogers, MN 55374-4515 |
Second Address | Rogers, MN 55374-4515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2021 |
Last Update Date | 22/02/2021 |