MEDICARE: SUSAN L PALMER PT

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	225100000X	Physical Therapist	11-02265	KS

General Provider Information

NPI Number	:	1902875065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN L PALMER PT

Provider Business Mailing Address
First Line	:	10333 E 21ST ST N
Second Line	:	STE 406
City	:	WICHITA
State	:	KS
Zip	:	67206-3543
Country	:	US
Telephone Number	:	316-630-9944
Fax Number	:

Provider Business Practice Location Address
First Line	:	10333 E 21ST ST N
Second Line	:	STE 406
City	:	WICHITA
State	:	KS
Zip	:	67206-3543
Country	:	US
Telephone Number	:	316-630-9944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	07/23/2013

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Directions to “ SUSAN L PALMER PT” Practice Location

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