Healthcare Provider Details

I. General information

NPI: 1447170683
Provider Name (Legal Business Name): DWIGHT ANDREW PARKER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36017 BELLA VISTA DR
YUCAIPA CA
92399-4932
US

IV. Provider business mailing address

36017 BELLA VISTA DR
YUCAIPA CA
92399-4932
US

V. Phone/Fax

Practice location:
  • Phone: 909-534-4484
  • Fax:
Mailing address:
  • Phone: 909-534-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: