Healthcare Provider Details

I. General information

NPI: 1982524526
Provider Name (Legal Business Name): THOMASTINE PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39111 6 MILE RD
LIVONIA MI
48152-3909
US

IV. Provider business mailing address

39111 6 MILE RD
LIVONIA MI
48152-3909
US

V. Phone/Fax

Practice location:
  • Phone: 866-991-0900
  • Fax:
Mailing address:
  • Phone: 866-991-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06007104A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: