Basic Information
| Provider Information | |||||||||
| NPI: | 1598171324 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | BLAKE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 CORPORATE DR | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232064158 | ||||||||
| FaxNumber: | 7177734654 | ||||||||
| Practice Location | |||||||||
| Address1: | 1112 HIGHWAY 278 E | ||||||||
| Address2: | |||||||||
| City: | AMORY | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388215626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622574048 | ||||||||
| FaxNumber: | 6622574080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2014 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | TN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PTH8824 | AL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT5598 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.