MEDICARE: DOREEN PALMER-PEREZ

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
1	225200000X	Physical Therapy Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PTA18385	OTHER	FL	LICENSE#

General Provider Information

NPI Number	:	1215002092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOREEN PALMER-PEREZ

Provider Business Mailing Address
First Line	:	2185 SUMMER BROOK ST
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-7178
Country	:	US
Telephone Number	:	321-426-9059
Fax Number	:

Provider Business Practice Location Address
First Line	:	7000 SPYGLASS CT
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-8288
Country	:	US
Telephone Number	:	321-259-9606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/08/2007

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Directions to “ DOREEN PALMER-PEREZ ” Practice Location

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