Provider Demographics
NPI:1679908677
Name:PALMER, BRETT DOUGLAS (PT)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:DOUGLAS
Last Name:PALMER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 POTTERY AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2501
Mailing Address - Country:US
Mailing Address - Phone:360-329-7052
Mailing Address - Fax:360-329-7053
Practice Address - Street 1:1950 POTTERY AVE STE 110
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2501
Practice Address - Country:US
Practice Address - Phone:360-329-7052
Practice Address - Fax:360-329-7053
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60392890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist