Provider Demographics
NPI:1336270396
Name:PALMER, ANN MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:PALMER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 SOUTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3866
Mailing Address - Country:US
Mailing Address - Phone:817-722-8560
Mailing Address - Fax:
Practice Address - Street 1:5601 BRIDGE ST STE 230
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-2306
Practice Address - Country:US
Practice Address - Phone:817-309-9748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2012365225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant