Healthcare Provider Details

I. General information

NPI: 1992452569
Provider Name (Legal Business Name): MADISON MARGARET PARKS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8651 JOHN T WHITE RD STE 121
FORT WORTH TX
76120-2766
US

IV. Provider business mailing address

3333 BLEECKER ST APT 411
COPPELL TX
75019-5381
US

V. Phone/Fax

Practice location:
  • Phone: 817-542-0714
  • Fax:
Mailing address:
  • Phone: 918-845-5110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1357797
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: