Provider Demographics
NPI:1538109814
Name:PARKER, GARY G JR (PT)
Entity Type:Individual
Prefix:PROF
First Name:GARY
Middle Name:G
Last Name:PARKER
Suffix:JR
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:PO BOX 613
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:NY
Mailing Address - Zip Code:13778-0613
Mailing Address - Country:US
Mailing Address - Phone:607-316-0987
Mailing Address - Fax:
Practice Address - Street 1:7 S CANAL ST STE 101
Practice Address - Street 2:
Practice Address - City:GREENE
Practice Address - State:NY
Practice Address - Zip Code:13778-1288
Practice Address - Country:US
Practice Address - Phone:607-656-4464
Practice Address - Fax:607-656-4593
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023101225100000X
NY018993174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02140229Medicaid
NYCC5929Medicare PIN
NY02140229Medicaid