Healthcare Provider Details

I. General information

NPI: 1205558848
Provider Name (Legal Business Name): CARRIE ANN PARKER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BROADHOLLOW RD
MELVILLE NY
11747-4992
US

IV. Provider business mailing address

83 JOANNE DR
HOLBROOK NY
11741-5604
US

V. Phone/Fax

Practice location:
  • Phone: 631-990-4352
  • Fax:
Mailing address:
  • Phone: 631-872-7987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number008724
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: