Provider Demographics
NPI:1922476068
Name:PALMGREN, ELIZABETH (CPTA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:PALMGREN
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 N GOVERNEOUR ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1700
Mailing Address - Country:US
Mailing Address - Phone:316-858-3961
Mailing Address - Fax:316-719-4796
Practice Address - Street 1:2828 N GOVERNEOUR ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1700
Practice Address - Country:US
Practice Address - Phone:316-858-3961
Practice Address - Fax:316-719-4796
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-07
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02576225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant