Provider Demographics
NPI:1952175317
Name:PARKS, TERRI LYNN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:LYNN
Last Name:PARKS
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 CHASE AVE
Mailing Address - Street 2:A-2-L
Mailing Address - City:RUSSELLS POIN
Mailing Address - State:OH
Mailing Address - Zip Code:43348-9732
Mailing Address - Country:US
Mailing Address - Phone:740-396-2154
Mailing Address - Fax:
Practice Address - Street 1:130 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1106
Practice Address - Country:US
Practice Address - Phone:937-644-4310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH166667225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist