Provider Demographics
NPI:1922675412
Name:PARKER, COURTNEY DANIEL
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DANIEL
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LYNN
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42 SUMMIT LOOP # B2
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-8789
Mailing Address - Country:US
Mailing Address - Phone:832-444-3406
Mailing Address - Fax:
Practice Address - Street 1:42 SUMMIT LOOP # B2
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-8789
Practice Address - Country:US
Practice Address - Phone:832-444-3406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012372225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist