Basic Information
| Provider Information | |||||||||
| NPI: | 1114234127 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | MT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 TOWN CTR STE 2001 | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480751116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483520314 | ||||||||
| FaxNumber: | 2482810759 | ||||||||
| Practice Location | |||||||||
| Address1: | 21700 NORTHWESTERN HWY STE 660 | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480754932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489148840 | ||||||||
| FaxNumber: | 2485699360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2010 | ||||||||
| LastUpdateDate: | 09/13/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.