Provider Demographics
NPI:1841067097
Name:PARKER, JUSTIN SHAWN (DPT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:SHAWN
Last Name:PARKER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 WOODBOURNE RD STE B
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19057-1540
Mailing Address - Country:US
Mailing Address - Phone:267-630-5740
Mailing Address - Fax:
Practice Address - Street 1:1411 WOODBOURNE RD STE B
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057-1540
Practice Address - Country:US
Practice Address - Phone:267-630-5740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT031926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist