Provider Demographics
NPI:1790012417
Name:PARKER, STEPHEN (CMT, LMT)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:PARKER
Suffix:
Gender:M
Credentials:CMT, LMT
Other - Prefix:MR
Other - First Name:SAID
Other - Middle Name:
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT, LMT
Mailing Address - Street 1:3647 CEDAR AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-2919
Mailing Address - Country:US
Mailing Address - Phone:612-728-0223
Mailing Address - Fax:
Practice Address - Street 1:3647 CEDAR AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-2919
Practice Address - Country:US
Practice Address - Phone:612-728-0223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor