Provider Demographics
NPI:1487834198
Name:PALMER, LYDIA (PT)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:PALMER
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 1:534 OWL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-6285
Mailing Address - Country:US
Mailing Address - Phone:770-361-4124
Mailing Address - Fax:678-290-5587
Practice Address - Street 1:534 OWL CREEK DR
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-6285
Practice Address - Country:US
Practice Address - Phone:770-361-4124
Practice Address - Fax:678-290-5587
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist