1376805929 NPI number — MS. JOAN ELIZABETH PARKER P.T.

Table of content: MS. JOAN ELIZABETH PARKER P.T. (NPI 1376805929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376805929 NPI number — MS. JOAN ELIZABETH PARKER P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
JOAN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

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:
1376805929
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 866863
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75086-6863
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-497-5684
Provider Business Mailing Address Fax Number:
610-968-4493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2304 TUSCANY DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORINTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76210-0599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-977-1307
Provider Business Practice Location Address Fax Number:
610-968-4493
Provider Enumeration Date:
06/11/2012

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:  1199260 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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