Provider Demographics
NPI:1750544458
Name:PALMER, LAUREN D (MPT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:D
Last Name:PALMER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10117 DEER CHASE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1357
Mailing Address - Country:US
Mailing Address - Phone:301-467-6557
Mailing Address - Fax:
Practice Address - Street 1:7101 RIVERWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1246
Practice Address - Country:US
Practice Address - Phone:240-233-2077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD233580OtherMEDICARE PTAN