Provider Demographics
NPI:1356305056
Name:PARROT-WILLIS, JUDY E (PT)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:E
Last Name:PARROT-WILLIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8051
Mailing Address - Fax:
Practice Address - Street 1:2 ESSEX CENTER DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2902
Practice Address - Country:US
Practice Address - Phone:978-977-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP00087787OtherMEDICARE RAILROAD
MA0396125Medicaid
MAHV0001OtherHARVARD PILGRIM
MA0014464OtherNEIGHBORHOOD HEALTH PLAN
MAB501027OtherCIGNA
MAY67454OtherBLUE CROSS
MA908025OtherTUFTS HEALTH PLAN
MA0014464OtherNEIGHBORHOOD HEALTH PLAN