Provider Demographics
NPI:1245683812
Name:PARKER, AMY (PT, DPT, COMT)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:PT, DPT, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 TUSCAN AVE
Mailing Address - Street 2:WCU BOX 9
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-5461
Mailing Address - Country:US
Mailing Address - Phone:601-318-6713
Mailing Address - Fax:601-318-6585
Practice Address - Street 1:498 TUSCAN AVE
Practice Address - Street 2:WCU BOX 9
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-5461
Practice Address - Country:US
Practice Address - Phone:601-318-6713
Practice Address - Fax:601-318-6585
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist