Healthcare Provider Details

I. General information

NPI: 1518352194
Provider Name (Legal Business Name): JOSHUA DAVID PALMER PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 PARSONS AVE
COLUMBUS OH
43207
US

IV. Provider business mailing address

2780 AIRPORT DRIVE SUITE 100 - BILLING/CREDENTIALING DEPT.
COLUMBUS OH
43219-2289
US

V. Phone/Fax

Practice location:
  • Phone: 614-586-4159
  • Fax: 614-586-4252
Mailing address:
  • Phone: 614-645-5500
  • Fax: 614-645-5517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA.07827
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: