Provider Demographics
NPI:1689171308
Name:PARKER PHYSIOTHERAPY, INC.
Entity Type:Organization
Organization Name:PARKER PHYSIOTHERAPY, INC.
Other - Org Name:PARKER PHYSIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:714-308-8579
Mailing Address - Street 1:2931 C ST UNIT 371
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-2287
Mailing Address - Country:US
Mailing Address - Phone:714-308-8579
Mailing Address - Fax:
Practice Address - Street 1:560 N COAST HIGHWAY 101 STE 4A
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2039
Practice Address - Country:US
Practice Address - Phone:858-900-3361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA433572251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty