Healthcare Provider Details

I. General information

NPI: 1295295913
Provider Name (Legal Business Name): CHARLES EDWIN PARKER III PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 SCHANCK RD STE B-17
FREEHOLD NJ
07728-2964
US

IV. Provider business mailing address

1 SWIMMING RIVER CT
BARNEGAT NJ
08005-5624
US

V. Phone/Fax

Practice location:
  • Phone: 732-414-6060
  • Fax:
Mailing address:
  • Phone: 646-358-6054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01846900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: