Provider Demographics
NPI:1861443970
Name:PARKER, MARY Y (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:Y
Last Name:PARKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 TOWSON AVE
Mailing Address - Street 2:SUITE L0LA
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-7994
Mailing Address - Country:US
Mailing Address - Phone:479-709-7000
Mailing Address - Fax:479-709-7051
Practice Address - Street 1:4500 TOWSON AVE
Practice Address - Street 2:SUITE L0LA
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-7994
Practice Address - Country:US
Practice Address - Phone:479-709-7000
Practice Address - Fax:479-709-7051
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5U331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U331OtherAR BLUE CROSS BLUE SHIELD