Provider Demographics
NPI:1699384297
Name:PALMER, KATIE B (PT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:B
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 1:13575 HEATHCOTE BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-6693
Mailing Address - Country:US
Mailing Address - Phone:804-698-9246
Mailing Address - Fax:
Practice Address - Street 1:13575 HEATHCOTE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-6693
Practice Address - Country:US
Practice Address - Phone:804-698-9246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052136522251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic