1386917136 NPI number — STEPHANIE LOUISE PALMATEER DPT

Table of content: STEPHANIE LOUISE PALMATEER DPT (NPI 1386917136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386917136 NPI number — STEPHANIE LOUISE PALMATEER DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALMATEER
Provider First Name:
STEPHANIE
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAGGETT
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386917136
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
878 S ROCHESTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48307-2767
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-601-9207
Provider Business Mailing Address Fax Number:
248-650-8670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23211 21 MILE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACOMB
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48042-5184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-231-0043
Provider Business Practice Location Address Fax Number:
586-741-8953
Provider Enumeration Date:
02/09/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5501015824 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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