Provider Demographics
NPI:1174575260
Name:PALMER, LOURDES M (PT)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:M
Last Name:PALMER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15207 SW 176TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-1620
Mailing Address - Country:US
Mailing Address - Phone:305-562-4493
Mailing Address - Fax:305-235-5050
Practice Address - Street 1:15207 SW 176TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-1620
Practice Address - Country:US
Practice Address - Phone:305-209-5050
Practice Address - Fax:305-235-5050
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17965225100000X
FL179652251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004481800Medicaid