Healthcare Provider Details

I. General information

NPI: 1407719735
Provider Name (Legal Business Name): RYAN DAVID PARKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 E FLORENCE BLVD STE 102
CASA GRANDE AZ
85122-4783
US

IV. Provider business mailing address

1828 E FLORENCE BLVD STE 102
CASA GRANDE AZ
85122-4783
US

V. Phone/Fax

Practice location:
  • Phone: 520-510-0360
  • Fax: 520-858-0174
Mailing address:
  • Phone: 520-510-0360
  • Fax: 520-858-0174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number054917
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-035018
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP24582
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: