Provider Demographics
NPI:1619156304
Name:PALMER, CARLA MARIE CORNETT (PT)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:MARIE CORNETT
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:PO BOX 2847
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24143-2847
Mailing Address - Country:US
Mailing Address - Phone:540-505-4281
Mailing Address - Fax:229-890-3397
Practice Address - Street 1:4770 BASELINE RD STE 120
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2667
Practice Address - Country:US
Practice Address - Phone:303-529-7664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23575225100000X
COPTL0018516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist