Provider Demographics
NPI:1699203455
Name:PALMER, KYLE (PT)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:PALMER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-3014
Mailing Address - Country:US
Mailing Address - Phone:509-780-1090
Mailing Address - Fax:
Practice Address - Street 1:621 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1871
Practice Address - Country:US
Practice Address - Phone:509-769-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60736008225100000X
IDPT-5916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist