Provider Demographics
NPI:1295295913
Name:PARKER, CHARLES EDWIN III (PT)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWIN
Last Name:PARKER
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 SANDPIPER RD
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-2153
Mailing Address - Country:US
Mailing Address - Phone:609-698-2139
Mailing Address - Fax:
Practice Address - Street 1:387 BRICK BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6010
Practice Address - Country:US
Practice Address - Phone:732-477-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01846900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist