MEDICARE: DANA PALMER PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1467096651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANA PALMER PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	6150 SENECA ST # 36
Second Line	:
City	:	SPRING BROOK
State	:	NY
Zip	:	14140-9800
Country	:	US
Telephone Number	:	716-903-0802
Fax Number	:

Provider Business Practice Location Address
First Line	:	6150 SENECA ST # 36
Second Line	:
City	:	SPRING BROOK
State	:	NY
Zip	:	14140-9800
Country	:	US
Telephone Number	:	716-903-0802
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANA PALMER
Credential	:	PT
Telephone Number	:	716-903-0802

Provider Enumeration Date	:	10/31/2019
Last Update Date	:	10/31/2019

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