Provider Demographics
NPI:1104825082
Name:PALMER, MICHELLE LYNN (MPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:PALMER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EXECUTIVE DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-4236
Mailing Address - Country:US
Mailing Address - Phone:856-778-4400
Mailing Address - Fax:856-793-1759
Practice Address - Street 1:101 EXECUTIVE DR
Practice Address - Street 2:SUITE 8
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-4236
Practice Address - Country:US
Practice Address - Phone:856-778-4400
Practice Address - Fax:856-793-1759
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010060L225100000X
NJ40QA01124400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA077019SAVMedicare PIN
NJ085975S2KMedicare PIN