Provider Demographics
NPI:1114275138
Name:PALMER, ANDREA DANETTE (CMT LMT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DANETTE
Last Name:PALMER
Suffix:
Gender:F
Credentials:CMT LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11860 W 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6507
Mailing Address - Country:US
Mailing Address - Phone:303-906-0875
Mailing Address - Fax:
Practice Address - Street 1:4304 KIPLING ST
Practice Address - Street 2:B
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6818
Practice Address - Country:US
Practice Address - Phone:303-906-0875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13183225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist