Provider Demographics
NPI:1750862322
Name:PARKER, TERISA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:TERISA
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 BENS HILL RD
Mailing Address - Street 2:
Mailing Address - City:SABATTUS
Mailing Address - State:ME
Mailing Address - Zip Code:04280-4402
Mailing Address - Country:US
Mailing Address - Phone:207-869-0423
Mailing Address - Fax:
Practice Address - Street 1:16C LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-1912
Practice Address - Country:US
Practice Address - Phone:207-869-0423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT4628225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist