Healthcare Provider Details

I. General information

NPI: 1245156892
Provider Name (Legal Business Name): PARKER BLEDSOE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 FOREST DR STE 145
ANNAPOLIS MD
21401-4211
US

IV. Provider business mailing address

25992 SERENATA DR
MISSION VIEJO CA
92691-5730
US

V. Phone/Fax

Practice location:
  • Phone: 301-798-4838
  • Fax:
Mailing address:
  • Phone: 949-636-8382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30921
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: