Provider Demographics
NPI:1013172857
Name:PARKER, JARRED ANTHONY (MS, PT)
Entity Type:Individual
Prefix:MR
First Name:JARRED
Middle Name:ANTHONY
Last Name:PARKER
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CAMDEN WAY
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3236
Mailing Address - Country:US
Mailing Address - Phone:860-940-5477
Mailing Address - Fax:
Practice Address - Street 1:240 EAST ST
Practice Address - Street 2:SELECT PHYSICAL THERAPY
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-2935
Practice Address - Country:US
Practice Address - Phone:860-793-6882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0076312251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT007631OtherLICENSE