Healthcare Provider Details

I. General information

NPI: 1043743123
Provider Name (Legal Business Name): MALIK PARKER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 TOLEDO TER STE A1
HYATTSVILLE MD
20782-4136
US

IV. Provider business mailing address

708 FOREST GLEN RD
SILVER SPRING MD
20901-2210
US

V. Phone/Fax

Practice location:
  • Phone: 301-853-0093
  • Fax:
Mailing address:
  • Phone: 240-383-6626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number26421
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: