Healthcare Provider Details

I. General information

NPI: 1164419172
Provider Name (Legal Business Name): PALM ORTHOPEDICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 4TH AVE N
NAPLES FL
34102-5733
US

IV. Provider business mailing address

883 4TH AVE N
NAPLES FL
34102-5733
US

V. Phone/Fax

Practice location:
  • Phone: 239-262-2797
  • Fax: 239-262-8663
Mailing address:
  • Phone: 239-262-2797
  • Fax: 239-262-8663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberPOR 27
License Number StateFL

VIII. Authorized Official

Name: JOHN P ATKINSON
Title or Position: PRES
Credential: CPO, RPH
Phone: 239-262-2797