Individual
MIKE JOHN PALMISANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS ATC
Contact information
Practice address
4402 CHURCHMAN AVE, SUITE 103, LOUISVILLE, KY 40215-1190
(502) 361-5253
Mailing address
7400 WOLFPEN WOODS CT, PROSPECT, KY 40059-7106
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT112
KY
Other
Enumeration date
06/27/2006
Last updated
07/08/2007
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