Healthcare Provider Details

I. General information

NPI: 1588693162
Provider Name (Legal Business Name): GERALD PARRA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 US HIGHWAY 41
SCHERERVILLE IN
46375-1201
US

IV. Provider business mailing address

625 ENTERPRISE DR
OAK BROOK IL
60523-8813
US

V. Phone/Fax

Practice location:
  • Phone: 219-923-4832
  • Fax: 219-923-4838
Mailing address:
  • Phone: 630-575-6250
  • Fax: 630-575-7450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05006345A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: