MEDICARE: MRS. MARY PATRICIA PALMA PT

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	225100000X	Physical Therapist	NJ40QA00191200	NJ

General Provider Information

NPI Number	:	1407288418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY PATRICIA PALMA PT

Provider Business Mailing Address
First Line	:	272 WESTVILLE AVE
Second Line	:
City	:	WEST CALDWELL
State	:	NJ
Zip	:	07006-7437
Country	:	US
Telephone Number	:	973-228-7644
Fax Number	:

Provider Business Practice Location Address
First Line	:	272 WESTVILLE AVE
Second Line	:
City	:	WEST CALDWELL
State	:	NJ
Zip	:	07006-7437
Country	:	US
Telephone Number	:	973-228-7644
Fax Number	:

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

Provider Enumeration Date	:	07/31/2013
Last Update Date	:	07/31/2013

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