Provider Demographics
NPI:1912242850
Name:PARRIS, KERRY RYAN (LPTA)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:RYAN
Last Name:PARRIS
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 COUNTY ROAD 1428
Mailing Address - Street 2:
Mailing Address - City:VINEMONT
Mailing Address - State:AL
Mailing Address - Zip Code:35179-7910
Mailing Address - Country:US
Mailing Address - Phone:256-339-8666
Mailing Address - Fax:
Practice Address - Street 1:970 COUNTY ROAD 1428
Practice Address - Street 2:
Practice Address - City:VINEMONT
Practice Address - State:AL
Practice Address - Zip Code:35179-7910
Practice Address - Country:US
Practice Address - Phone:256-339-8666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA5936225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant