Provider Demographics
NPI:1861878472
Name:PALMER, BENJAMIN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:PALMER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28515 N NORTH VALLEY PKWY
Mailing Address - Street 2:APT 2011
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-5401
Mailing Address - Country:US
Mailing Address - Phone:847-942-5959
Mailing Address - Fax:
Practice Address - Street 1:1611 W WHISPERING WIND DR
Practice Address - Street 2:SUITE 4
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-0649
Practice Address - Country:US
Practice Address - Phone:602-345-1984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist