Provider Demographics
NPI:1760588339
Name:PARKER, ROBERT JEFFREY (PT,OCS,MS,ATC,COMT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JEFFREY
Last Name:PARKER
Suffix:
Gender:M
Credentials:PT,OCS,MS,ATC,COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10624 N KENSINGTON CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-2445
Mailing Address - Country:US
Mailing Address - Phone:509-465-0597
Mailing Address - Fax:
Practice Address - Street 1:10624 N KENSINGTON CT
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-2445
Practice Address - Country:US
Practice Address - Phone:509-465-0597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 7332225100000X, 2251X0800X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8378358Medicaid
WA8853816Medicare ID - Type Unspecified