Provider Demographics
NPI:1710126826
Name:PALMER, EDWARD CLARK (PT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:CLARK
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 1:4 WEST ST
Mailing Address - Street 2:
Mailing Address - City:WEST HATFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01088-9515
Mailing Address - Country:US
Mailing Address - Phone:413-570-1177
Mailing Address - Fax:413-570-1180
Practice Address - Street 1:4 WEST ST
Practice Address - Street 2:
Practice Address - City:WEST HATFIELD
Practice Address - State:MA
Practice Address - Zip Code:01088-9515
Practice Address - Country:US
Practice Address - Phone:413-570-1177
Practice Address - Fax:413-570-1180
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2558225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist