Provider Demographics
NPI:1477033611
Name:PALMA, MARIA LOURDES ANCHETA (PT)
Entity Type:Individual
Prefix:
First Name:MARIA LOURDES
Middle Name:ANCHETA
Last Name:PALMA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 WYNBROOKEE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-8679
Mailing Address - Country:US
Mailing Address - Phone:252-224-1012
Mailing Address - Fax:
Practice Address - Street 1:302 WYNBROOKEE LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-8679
Practice Address - Country:US
Practice Address - Phone:252-224-1012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist