Provider Demographics
NPI:1942420807
Name:PARSONS, GRACE MARILYN (PT)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:MARILYN
Last Name:PARSONS
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 1:304 LUCERNE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-3918
Mailing Address - Country:US
Mailing Address - Phone:954-461-9084
Mailing Address - Fax:561-588-3866
Practice Address - Street 1:304 LUCERNE AVE
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-3918
Practice Address - Country:US
Practice Address - Phone:954-461-9084
Practice Address - Fax:561-588-3866
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY043DOtherBLUECROSS BLUE SHIELD
FLY043DOtherBLUECROSS BLUE SHIELD