Healthcare Provider Details

I. General information

NPI: 1134837578
Provider Name (Legal Business Name): JAKE DALTON PARLER DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/14/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 FOREST ACRES
COLUMBIA SC
29204
US

IV. Provider business mailing address

105 OLD CARRIAGE LN
BARNWELL SC
29812-8061
US

V. Phone/Fax

Practice location:
  • Phone: 803-764-2363
  • Fax:
Mailing address:
  • Phone: 803-671-1908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11618
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: