Healthcare Provider Details

I. General information

NPI: 1215699046
Provider Name (Legal Business Name): PARKER RAYMOND VINCENT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 N WASHINGTON AVE
GLENDORA CA
91741-2558
US

IV. Provider business mailing address

338 N WASHINGTON AVE
GLENDORA CA
91741-2558
US

V. Phone/Fax

Practice location:
  • Phone: 626-257-6240
  • Fax:
Mailing address:
  • Phone: 626-257-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number301127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: