Provider Demographics
NPI:1013109362
Name:PARKER, AMY MICHELLE (PTA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
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 1:2090 SFC 130
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:AR
Mailing Address - Zip Code:72372-9236
Mailing Address - Country:US
Mailing Address - Phone:870-317-6275
Mailing Address - Fax:
Practice Address - Street 1:3424 OAKMONT DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9502
Practice Address - Country:US
Practice Address - Phone:870-243-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 2103225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant