Provider Demographics
NPI:1750458345
Name:PARKER PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:PARKER PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, CPC
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-364-6793
Mailing Address - Street 1:7615 COLONY RD STE 110
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5018
Mailing Address - Country:US
Mailing Address - Phone:704-364-6793
Mailing Address - Fax:704-364-3171
Practice Address - Street 1:7615 COLONY RD STE 110
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5018
Practice Address - Country:US
Practice Address - Phone:704-364-6793
Practice Address - Fax:704-364-3171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4819261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC58687OtherMEDCOST PROV #
NC0775DOtherBCBS PROV #
NC2501932OtherMEDICARE PTAN
NC650021133OtherRR MCARE PROV #
NC16542OtherPARTNERS PROV #
NC7200091Medicaid
NC650021133OtherRR MCARE PROV #