Provider Demographics
NPI:1942614920
Name:PARKINSON WELLNESS CLINIC, LLC
Entity Type:Organization
Organization Name:PARKINSON WELLNESS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-780-8748
Mailing Address - Street 1:5151 E BROADWAY BLVD
Mailing Address - Street 2:SUITE 1600, MAILBOX #163
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711
Mailing Address - Country:US
Mailing Address - Phone:520-780-8748
Mailing Address - Fax:520-333-3048
Practice Address - Street 1:5151 E BROADWAY BLVD
Practice Address - Street 2:SUITE 1600, #163
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3705
Practice Address - Country:US
Practice Address - Phone:520-780-8748
Practice Address - Fax:520-333-3048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41359261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty