Provider Demographics
NPI:1063957553
Name:PALMER, THOMAS G (PHD, ATC, CSCSD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:PALMER
Suffix:
Gender:M
Credentials:PHD, ATC, CSCSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 EDEN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-0394
Mailing Address - Country:US
Mailing Address - Phone:513-556-6000
Mailing Address - Fax:513-558-7474
Practice Address - Street 1:3202 EDEN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-0394
Practice Address - Country:US
Practice Address - Phone:513-556-6000
Practice Address - Fax:513-558-7474
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0040732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAT004073OtherCERTIFIED ATHLETIC TRAINER