Basic Information
Provider Information
NPI: 1093231714
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PALMER
FirstName: JAMES
MiddleName:  
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NameSuffix:  
Credential: DPT,ATC
OtherOrganizationName:  
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Mailing Information
Address1: 4200 DAHLBERG DR STE 300
Address2:  
City: GOLDEN VALLEY
State: MN
PostalCode: 554224841
CountryCode: US
TelephoneNumber: 7635207870
FaxNumber: 7635207580
Practice Location
Address1: 4100 MINNESOTA DR
Address2:  
City: EDINA
State: MN
PostalCode: 55435
CountryCode: US
TelephoneNumber: 9524567000
FaxNumber: 9524567598
Other Information
ProviderEnumerationDate: 08/15/2017
LastUpdateDate: 09/27/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
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AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2255A2300XAT-626IDN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
225100000X11294MNY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
2255A2300XAL3967FLN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
2251S0007XPT-5264IDN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
2255A2300X1947WIN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer

No ID Information.


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