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NPI Code Detail

MEDICARE: THOMAS G PALMER PHD, ATC, CSCS.D

MEDICARE: THOMAS G PALMER PHD, ATC, CSCS.D
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
12255A2300XAthletic TrainerAT004073OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AT004073OTHEROHCERTIFIED ATHLETIC TRAINER

General Provider Information

NPI Number : 1063957553
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS G PALMER PHD, ATC, CSCS.D
Provider Business Mailing Address
First Line : 3202 EDEN AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45267-0394
Country : US
Telephone Number : 513-556-6000
Fax Number : 513-558-7474
Provider Business Practice Location Address
First Line : 3202 EDEN AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45267-0394
Country : US
Telephone Number : 513-556-6000
Fax Number : 513-558-7474
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2016
Last Update Date : 12/20/2016

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