Provider Demographics
NPI:1043396203
Name:PALMER, JENNIFER LYN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYN
Last Name:PALMER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYN
Other - Last Name:DICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:15386 W EVANS DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-6451
Mailing Address - Country:US
Mailing Address - Phone:303-522-6126
Mailing Address - Fax:
Practice Address - Street 1:425 S CHERRY ST
Practice Address - Street 2:640
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1226
Practice Address - Country:US
Practice Address - Phone:303-333-3493
Practice Address - Fax:303-333-1184
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO804680Medicare PIN