Provider Demographics
NPI:1811879752
Name:PALMER, MATHIAS MAR (PTA)
Entity type:Individual
Prefix:
First Name:MATHIAS
Middle Name:MAR
Last Name:PALMER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 SADDLESHOP ROAD
Mailing Address - Street 2:
Mailing Address - City:HILLTOP
Mailing Address - State:WV
Mailing Address - Zip Code:25855-5549
Mailing Address - Country:US
Mailing Address - Phone:304-469-2966
Mailing Address - Fax:
Practice Address - Street 1:152 SADDLESHOP ROAD
Practice Address - Street 2:
Practice Address - City:HILLTOP
Practice Address - State:WV
Practice Address - Zip Code:25855
Practice Address - Country:US
Practice Address - Phone:340-469-2966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002975225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant