Provider Demographics
NPI:1346961406
Name:NALLY, PARKER DEAN (DPT)
Entity Type:Individual
Prefix:
First Name:PARKER
Middle Name:DEAN
Last Name:NALLY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6296
Mailing Address - Country:US
Mailing Address - Phone:978-886-4935
Mailing Address - Fax:
Practice Address - Street 1:65 PORTLAND RD STE 5
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6742
Practice Address - Country:US
Practice Address - Phone:207-985-6181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT6319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist