Provider Demographics
NPI:1679168033
Name:GAUDIO, PARKER (PT, DPT)
Entity Type:Individual
Prefix:
First Name:PARKER
Middle Name:
Last Name:GAUDIO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3970 S LAKE DR UNIT 18
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:WI
Mailing Address - Zip Code:53235-5237
Mailing Address - Country:US
Mailing Address - Phone:309-370-9486
Mailing Address - Fax:
Practice Address - Street 1:N26W23977 WATERTOWN RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1006
Practice Address - Country:US
Practice Address - Phone:262-523-0933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-07
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist