Provider Demographics
NPI:1851675482
Name:PARKER, SHAWN ALLAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:ALLAN
Last Name:PARKER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W 14 MILE RD STE B2
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-3100
Mailing Address - Country:US
Mailing Address - Phone:248-733-3885
Mailing Address - Fax:248-733-3885
Practice Address - Street 1:555 W 14 MILE RD STE B2
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-3100
Practice Address - Country:US
Practice Address - Phone:248-733-3885
Practice Address - Fax:248-566-0098
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015731225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1851675482Medicaid