Active NPI
Renee Fairs Palmer
- Physical Therapy Assistant
- Johnson City, NY
National Provider Identifier
1598822355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 003301-1
- Practice address
- 18 Broad St
Johnson City, NY 13790-2106 - Phone
- (607) 798-7117
- NPI assigned
- Jan 2, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 003301-1 | NY | Primary |
Addresses
Primary practice location
18 Broad St
Johnson City, NY 13790-2106
Mailing address
1026 Briarwood Dr
Endicott, NY 13760-7127
Phone (607) 754-3849
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003301-1 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1598822355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1026 BRIARWOOD DR",
"city": "ENDICOTT",
"state": "NY",
"postal_code": "137607127",
"telephone_number": "607-754-3849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18 BROAD ST",
"city": "JOHNSON CITY",
"state": "NY",
"postal_code": "137902106",
"telephone_number": "607-798-7117"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PALMER",
"first_name": "RENEE",
"middle_name": "FAIRS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NY",
"license": "003301-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Johnson City, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.