MEDICARE: MRS. ANNE MARIE PALMITIER 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
1	225100000X	Physical Therapist	5501010954	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P33910F	OTHER	MI	BLUE CARE NETWORK
2	20--0223019	OTHER	MI	TAX ID
3	650D114040	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1962409086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNE MARIE PALMITIER P.T.

Provider Business Mailing Address
First Line	:	4586 LYTHAM DR
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-8987
Country	:	US
Telephone Number	:	616-975-9078
Fax Number	:	616-975-9248

Provider Business Practice Location Address
First Line	:	4761 LAKE MICHIGAN DR NW
Second Line	:	SUITE A
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-6300
Country	:	US
Telephone Number	:	616-975-9078
Fax Number	:	616-975-9248

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	02/21/2013

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