Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 007631 | CT |
N | 2251X0800X | Physical Therapist - Orthopedic | 007631 | CT |
NPI | 1013172857 |
---|---|
Provider Name | Mr. Jarred Anthony Parker |
First Address | Avon, CT 06001-3236 |
Second Address | Plainville, CT 06062-2935 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2008 |
Last Update Date | 06/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007631 | LICENSE (01) | CT |