Healthcare Provider Details

I. General information

NPI: 1376940197
Provider Name (Legal Business Name): PALMER TROLLI ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PRINCETON UNIVERSITY
PRINCETON NJ
08544-0001
US

IV. Provider business mailing address

15 ROSE ARBOR LN
LEVITTOWN PA
19055-1412
US

V. Phone/Fax

Practice location:
  • Phone: 609-258-3141
  • Fax:
Mailing address:
  • Phone: 609-475-2718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT005923
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: