Provider Demographics
NPI:1770799900
Name:PALMER, PHILLIP BURL (PT)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:BURL
Last Name:PALMER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:221 YAHOOLA SHOALS DR
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-7508
Mailing Address - Country:US
Mailing Address - Phone:706-864-1469
Mailing Address - Fax:706-864-1493
Practice Address - Street 1:82 COLLEGE CIRCLE
Practice Address - Street 2:NORTH GEORGIA COLLEGE & STATE UNIVERSITY
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30597
Practice Address - Country:US
Practice Address - Phone:706-864-1469
Practice Address - Fax:706-864-1493
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1016434225100000X
GA1504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist