Provider Demographics
NPI:1033144753
Name:PARKER, DAVID CECIL (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CECIL
Last Name:PARKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7615 COLONY ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5018
Mailing Address - Country:US
Mailing Address - Phone:704-364-6793
Mailing Address - Fax:704-364-3171
Practice Address - Street 1:7615 COLONY RD STE 110
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5018
Practice Address - Country:US
Practice Address - Phone:704-364-6793
Practice Address - Fax:704-364-3171
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2501932OtherMEDICARE PTAN
NC2501932Medicare PIN