Provider Demographics
NPI:1417373168
Name:PALKOWSKI, PATRICK (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:PALKOWSKI
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 SW GOLDEN HILLS DR
Mailing Address - Street 2:APT D201
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-6701
Mailing Address - Country:US
Mailing Address - Phone:716-982-9763
Mailing Address - Fax:
Practice Address - Street 1:500 8TH AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2691
Practice Address - Country:US
Practice Address - Phone:208-200-2145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-4702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer