Provider Demographics
NPI:1447341425
Name:PALMER, JOHN C (DPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:PALMER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13975 COUNTY ROAD 136
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-6369
Mailing Address - Country:US
Mailing Address - Phone:386-364-6638
Mailing Address - Fax:
Practice Address - Street 1:13975 COUNTY ROAD 136
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060-6369
Practice Address - Country:US
Practice Address - Phone:386-364-6638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16368225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist