MEDICARE: ANN MARIE PALMER PTA

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	2012365	TX

General Provider Information

NPI Number	:	1336270396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MARIE PALMER PTA

Provider Business Mailing Address
First Line	:	2916 SOUTHRIDGE DR
Second Line	:
City	:	GRAPEVINE
State	:	TX
Zip	:	76051-3866
Country	:	US
Telephone Number	:	817-722-8560
Fax Number	:

Provider Business Practice Location Address
First Line	:	5601 BRIDGE ST STE 230
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-2306
Country	:	US
Telephone Number	:	817-309-9748
Fax Number	:

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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