1386641793 NPI number — DR. COURTNEY BRYANT PAREZO DPT

Table of content: DR. COURTNEY BRYANT PAREZO DPT (NPI 1386641793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386641793 NPI number — DR. COURTNEY BRYANT PAREZO DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAREZO
Provider First Name:
COURTNEY
Provider Middle Name:
BRYANT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRYANT
Provider Other First Name:
COURTNEY
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386641793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 W ROLLING XRDS STE 100-102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-6211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-747-1600
Provider Business Mailing Address Fax Number:
410-747-5202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 W ROLLING CROSSROADS
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21228-6208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-747-1600
Provider Business Practice Location Address Fax Number:
410-747-5202
Provider Enumeration Date:
06/30/2005

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: 225100000X , with the licence number:  20475 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2128350 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 224004100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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