Provider Demographics
NPI:1558560938
Name:PARKER, BETTY MECHELLE (PT)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:MECHELLE
Last Name:PARKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:MECHELLE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3688 VETERANS MEMORIAL DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-8246
Mailing Address - Country:US
Mailing Address - Phone:601-543-0221
Mailing Address - Fax:601-543-0201
Practice Address - Street 1:190 BEAUVOIR RD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-5004
Practice Address - Country:US
Practice Address - Phone:228-388-5714
Practice Address - Fax:228-388-0017
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist