Provider Demographics
NPI:1821256637
Name:PARKOLAY, MARY JO (MAC, LAC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:PARKOLAY
Suffix:
Gender:F
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14775 CHARMIAN RD
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:17214-9789
Mailing Address - Country:US
Mailing Address - Phone:877-298-5354
Mailing Address - Fax:
Practice Address - Street 1:14775 CHARMIAN RD
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:17214-9789
Practice Address - Country:US
Practice Address - Phone:877-298-5354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01490171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist