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NPI Code Detail

MEDICARE: MRS. SUSAN JEAN PALMQUIST P.T.

MEDICARE: MRS. SUSAN JEAN PALMQUIST P.T.
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
1167G00000XLicensed Psychiatric TechnicianPT29942CA

General Provider Information

NPI Number : 1760512909
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN JEAN PALMQUIST P.T.
Provider Business Mailing Address
First Line : 909 GLENCLIFF ST
Second Line :
City : LA HABRA
State : CA
Zip : 90631-6426
Country : US
Telephone Number : 562-413-9191
Fax Number :
Provider Business Practice Location Address
First Line : 6001 CLARA ST
Second Line :
City : BELL GARDENS
State : CA
Zip : 90201-4723
Country : US
Telephone Number : 562-806-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. SUSAN JEAN PALMQUIST P.T.” Practice Location

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