1215145859 NPI number — MR. THOMAS D PARKER PTA

Table of content: DR. DOUGLAS WHITNEY ASHTON DPT (NPI 1972900959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215145859 NPI number — MR. THOMAS D PARKER PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
THOMAS
Provider Middle Name:
D
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PTA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215145859
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 MARY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRACY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95376-1337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-833-3438
Provider Business Mailing Address Fax Number:
209-833-3438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 E STANLEY BLVD
Provider Second Line Business Practice Location Address:
STE. 112
Provider Business Practice Location Address City Name:
LIVERMORE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94550-4115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-243-1385
Provider Business Practice Location Address Fax Number:
925-243-0127
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  AT 1396 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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