Provider Demographics
NPI:1083986954
Name:PARRISH, DERIC (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DERIC
Middle Name:
Last Name:PARRISH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 WESTPORT RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-3819
Mailing Address - Country:US
Mailing Address - Phone:270-765-4263
Mailing Address - Fax:
Practice Address - Street 1:708 WESTPORT RD
Practice Address - Street 2:SUITE 202
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-3819
Practice Address - Country:US
Practice Address - Phone:270-765-4263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist