Provider Demographics
NPI:1700837655
Name:PALMER, GEORGE (PT)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
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 1:625 9TH AVENUE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632
Mailing Address - Country:US
Mailing Address - Phone:360-578-1188
Mailing Address - Fax:360-578-6251
Practice Address - Street 1:625 9TH AVENUE
Practice Address - Street 2:SUITE 220
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2544
Practice Address - Country:US
Practice Address - Phone:360-578-1188
Practice Address - Fax:360-578-6251
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA205245OtherDEPARTMENT OF LABOR AND I
WA8940636OtherCRIME VICTIMS
WA205245Medicaid
WA130909OtherKAISER PERMANENTE
WA8940636OtherCRIME VICTIMS