Provider Demographics
NPI:1295099976
Name:PARKER, ANDREA JESSE (DPT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:JESSE
Last Name:PARKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10505 19TH AVE SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4280
Mailing Address - Country:US
Mailing Address - Phone:408-570-0510
Mailing Address - Fax:408-945-4018
Practice Address - Street 1:12121 HARBOUR REACH DR
Practice Address - Street 2:#100
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5314
Practice Address - Country:US
Practice Address - Phone:425-493-8313
Practice Address - Fax:425-493-9614
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 60386882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8922995Medicare PIN