Provider Demographics
NPI:1003971540
Name:PARMENTER, BRAD A (MPT)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:A
Last Name:PARMENTER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 S. PACIFIC HWY., SUITE A
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-6650
Mailing Address - Country:US
Mailing Address - Phone:541-535-2551
Mailing Address - Fax:541-535-1417
Practice Address - Street 1:331 S. PACIFIC HWY., SUITE A
Practice Address - Street 2:
Practice Address - City:TALENT
Practice Address - State:OR
Practice Address - Zip Code:97540-6650
Practice Address - Country:US
Practice Address - Phone:541-535-2551
Practice Address - Fax:541-535-1417
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR208341Medicaid