Provider Demographics
NPI:1629187356
Name:PARKER, C BRUCE
Entity Type:Individual
Prefix:
First Name:C BRUCE
Middle Name:
Last Name:PARKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 49TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3608
Mailing Address - Country:US
Mailing Address - Phone:206-938-7555
Mailing Address - Fax:
Practice Address - Street 1:22757 72ND AVE S
Practice Address - Street 2:STE 102
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-2459
Practice Address - Country:US
Practice Address - Phone:253-872-4118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT00008848OtherLICENSE#