Healthcare Provider Details

I. General information

NPI: 1053404301
Provider Name (Legal Business Name): GARY EDWARD PALMER JR. BS, LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 UNIVERSITY AVE
ROCHESTER NY
14607-1225
US

IV. Provider business mailing address

36 EDGERTON ST DOWN
ROCHESTER NY
14607-2909
US

V. Phone/Fax

Practice location:
  • Phone: 585-271-8060
  • Fax:
Mailing address:
  • Phone: 585-325-3756
  • Fax: 585-935-7146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number018865
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: