Provider Demographics
NPI:1073909305
Name:PALMER, FLAVIA BUENO (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:FLAVIA
Middle Name:BUENO
Last Name:PALMER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 MISSION SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-1112
Mailing Address - Country:US
Mailing Address - Phone:703-969-1013
Mailing Address - Fax:
Practice Address - Street 1:3030 MISSION SQUARE DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-1112
Practice Address - Country:US
Practice Address - Phone:703-969-1013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist