Provider Demographics
NPI:1700815222
Name:PARKINSON, MICHAEL PATRICK (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:PARKINSON
Suffix:
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 1:630 S RAYMOND AVE
Mailing Address - Street 2:STE#120
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3278
Mailing Address - Country:US
Mailing Address - Phone:626-403-1444
Mailing Address - Fax:626-403-1448
Practice Address - Street 1:630 S RAYMOND AVE
Practice Address - Street 2:STE#120
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3278
Practice Address - Country:US
Practice Address - Phone:626-403-1444
Practice Address - Fax:626-403-1448
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13096Medicare ID - Type UnspecifiedGROUP NUMBER