Provider Demographics
NPI:1750319091
Name:PARSONIS, GARY MARK (MPT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:MARK
Last Name:PARSONIS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 DEERPATH DR
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2053
Mailing Address - Country:US
Mailing Address - Phone:727-784-6088
Mailing Address - Fax:727-784-3034
Practice Address - Street 1:29605 US HIGHWAY 19 N
Practice Address - Street 2:SUITE #360
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-1537
Practice Address - Country:US
Practice Address - Phone:727-784-6088
Practice Address - Fax:727-784-3034
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 18155174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDD5262OtherMEDICARE RAILROAD
FLY8438OtherBLUE CROSS
FL7817143OtherAETNA
FLDD5262OtherMEDICARE RAILROAD