Provider Demographics
NPI:1184188567
Name:PARKS, AARON (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:PARKS
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 JERICHO RD
Mailing Address - Street 2:
Mailing Address - City:HARMONY
Mailing Address - State:NC
Mailing Address - Zip Code:28634-9461
Mailing Address - Country:US
Mailing Address - Phone:304-960-1585
Mailing Address - Fax:
Practice Address - Street 1:5501 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023-8232
Practice Address - Country:US
Practice Address - Phone:336-945-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer