Provider Demographics
NPI:1669627295
Name:PARSHALL, VICKI LEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:LEE
Last Name:PARSHALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:VICKI
Other - Middle Name:LEE
Other - Last Name:PUTNAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:13320-0036
Mailing Address - Country:US
Mailing Address - Phone:607-287-2628
Mailing Address - Fax:607-264-9545
Practice Address - Street 1:9 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:CHERRY VALLEY
Practice Address - State:NY
Practice Address - Zip Code:13320-0036
Practice Address - Country:US
Practice Address - Phone:607-287-2628
Practice Address - Fax:607-264-9545
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011615-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics