Provider Demographics
NPI:1548229214
Name:PALMER, RANDALL KEITH (MED, ATC)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:KEITH
Last Name:PALMER
Suffix:
Gender:M
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:515 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-2121
Mailing Address - Country:US
Mailing Address - Phone:507-345-1746
Mailing Address - Fax:507-625-3854
Practice Address - Street 1:1431 PREMIERE DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6076
Practice Address - Country:US
Practice Address - Phone:507-386-6700
Practice Address - Fax:507-388-8372
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN10642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer