Provider Demographics
NPI:1952508053
Name:PARKER, TINA M (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:M
Last Name:PARKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13645 FREDERICKSBURG RD NW
Mailing Address - Street 2:
Mailing Address - City:DEPAUW
Mailing Address - State:IN
Mailing Address - Zip Code:47115-8303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 ANSON ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-1982
Practice Address - Country:US
Practice Address - Phone:812-883-4681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06000951A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant