Provider Demographics
NPI:1538473798
Name:PALMER, STACY LORRAINE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LORRAINE
Last Name:PALMER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2132
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35602-2132
Mailing Address - Country:US
Mailing Address - Phone:256-309-0454
Mailing Address - Fax:
Practice Address - Street 1:922 6TH AVE SE
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3907
Practice Address - Country:US
Practice Address - Phone:256-309-0454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH5904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist