Provider Demographics
NPI:1013516954
Name:PARKER, LAURENCE OLIVER
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:OLIVER
Last Name:PARKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7655 PARK NORTH DR APT 806
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77708-2413
Mailing Address - Country:US
Mailing Address - Phone:409-926-2808
Mailing Address - Fax:
Practice Address - Street 1:7655 PARK NORTH DR APT 806
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708-2413
Practice Address - Country:US
Practice Address - Phone:409-926-2808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2061886225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty