Provider Demographics
NPI:1053404301
Name:PALMER, GARY EDWARD JR (BS, LMT)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:EDWARD
Last Name:PALMER
Suffix:JR
Gender:M
Credentials:BS, LMT
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Mailing Address - Street 1:36 EDGERTON ST
Mailing Address - Street 2:DOWN
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2909
Mailing Address - Country:US
Mailing Address - Phone:585-325-3756
Mailing Address - Fax:585-935-7146
Practice Address - Street 1:721 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1225
Practice Address - Country:US
Practice Address - Phone:585-271-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY018865225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist