Provider Demographics
NPI:1962409086
Name:PALMITIER, ANNE MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:MARIE
Last Name:PALMITIER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4586 LYTHAM DR
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-8987
Mailing Address - Country:US
Mailing Address - Phone:616-975-9078
Mailing Address - Fax:616-975-9248
Practice Address - Street 1:4761 LAKE MICHIGAN DR NW
Practice Address - Street 2:SUITE A
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-6300
Practice Address - Country:US
Practice Address - Phone:616-975-9078
Practice Address - Fax:616-975-9248
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010954225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP33910FOtherBLUE CARE NETWORK
MI20--0223019OtherTAX ID
MI650D114040OtherBLUE CROSS BLUE SHIELD
MI20--0223019OtherTAX ID
MIN81330004Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER