Provider Demographics
NPI:1992288237
Name:PALMER, ERICA DANYELLE (DPT)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:DANYELLE
Last Name:PALMER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2743 MANHATTAN PL
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-7345
Mailing Address - Country:US
Mailing Address - Phone:504-782-7939
Mailing Address - Fax:
Practice Address - Street 1:5695 KING CENTRE DR STE 102
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5746
Practice Address - Country:US
Practice Address - Phone:703-924-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist