MEDICARE: MRS. BRENDA SUE PARKER RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	273	AR

General Provider Information

NPI Number	:	1588822654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRENDA SUE PARKER RPT

Provider Business Mailing Address
First Line	:	48 TENNYSON CT
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-4932
Country	:	US
Telephone Number	:	501-835-9655
Fax Number	:	501-378-0290

Provider Business Practice Location Address
First Line	:	6800 INDIAN HILLS DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-5330
Country	:	US
Telephone Number	:	501-835-5622
Fax Number	:	501-835-9580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	05/27/2008

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