Healthcare Provider Details

I. General information

NPI: 1558303230
Provider Name (Legal Business Name): TAMI K PARKER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 3RD ST NE
MAYVILLE ND
58257-1215
US

IV. Provider business mailing address

1425 S COLUMBIA RD
GRAND FORKS ND
58201-4039
US

V. Phone/Fax

Practice location:
  • Phone: 218-686-5479
  • Fax:
Mailing address:
  • Phone: 701-746-8374
  • Fax: 218-683-2595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6849
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1555
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: