MEDICARE: MRS. BEVERLY ATHEN PARKS RMT

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	225700000X	Massage Therapist	704	MS

General Provider Information

NPI Number	:	1831253319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BEVERLY ATHEN PARKS RMT

Provider Business Mailing Address
First Line	:	511 LOCUST HILL RD
Second Line	:
City	:	BELDEN
State	:	MS
Zip	:	38826-9376
Country	:	US
Telephone Number	:	662-842-4559
Fax Number	:

Provider Business Practice Location Address
First Line	:	323 LOCUST HILL RD
Second Line	:
City	:	BELDEN
State	:	MS
Zip	:	38826-9379
Country	:	US
Telephone Number	:	662-322-6186
Fax Number	:

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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