Provider Demographics
NPI:1760761811
Name:PARKER, STEPHEN (PTA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:PARKER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 HOLLIS TER
Mailing Address - Street 2:
Mailing Address - City:COTTONTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37048-9601
Mailing Address - Country:US
Mailing Address - Phone:615-818-5830
Mailing Address - Fax:
Practice Address - Street 1:1212 HOLLIS TER
Practice Address - Street 2:
Practice Address - City:COTTONTOWN
Practice Address - State:TN
Practice Address - Zip Code:37048-9601
Practice Address - Country:US
Practice Address - Phone:615-818-5830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN192171100000X
TNPTA0000006610225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No171100000XOther Service ProvidersAcupuncturist