Provider Demographics
NPI:1023414018
Name:PARKER, BRIAN SR (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:PARKER
Suffix:SR
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3755 PINEY BOUGH DR
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-8938
Mailing Address - Country:US
Mailing Address - Phone:936-662-8233
Mailing Address - Fax:
Practice Address - Street 1:3755 PINEY BOUGH DR
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-8938
Practice Address - Country:US
Practice Address - Phone:936-662-8233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT28192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer