Provider Demographics
NPI:1811955750
Name:PARKER, CAMILLA CRUMP (PT)
Entity type:Individual
Prefix:MRS
First Name:CAMILLA
Middle Name:CRUMP
Last Name:PARKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2586 HIGHWAY 17 SOUTH
Mailing Address - Street 2:UNIT C&D
Mailing Address - City:GARDEN CITY BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29576-6605
Mailing Address - Country:US
Mailing Address - Phone:843-651-6565
Mailing Address - Fax:843-651-6575
Practice Address - Street 1:2586 HIGHWAY 17 SOUTH
Practice Address - Street 2:UNIT C&D
Practice Address - City:GARDEN CITY BEACH
Practice Address - State:SC
Practice Address - Zip Code:29576-6605
Practice Address - Country:US
Practice Address - Phone:843-651-6565
Practice Address - Fax:843-651-6575
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist