Provider Demographics
NPI:1992758916
Name:PALMA, M GUIA
Entity type:Individual
Prefix:
First Name:M
Middle Name:GUIA
Last Name:PALMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:M
Other - Middle Name:GUIA
Other - Last Name:RAZON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-833-5900
Mailing Address - Fax:319-833-5901
Practice Address - Street 1:125 E TOWER PARK DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-9330
Practice Address - Country:US
Practice Address - Phone:319-232-6339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0491811Medicaid
IA17331OtherWELLMARK INS PLAN
IA0491811Medicaid