Provider Demographics
NPI:1558920116
Name:CONDE-PALMER, NICHOLAS (ATC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:CONDE-PALMER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 THORNCREST DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-9509
Mailing Address - Country:US
Mailing Address - Phone:919-924-7532
Mailing Address - Fax:
Practice Address - Street 1:134 SPORTS CAMP DR
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:PA
Practice Address - Zip Code:16882-8422
Practice Address - Country:US
Practice Address - Phone:814-303-5938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer