Healthcare Provider Details

I. General information

NPI: 1871408435
Provider Name (Legal Business Name): MARINDA PARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 RIVER TRAIL RD
PIPE CREEK TX
78063-6099
US

IV. Provider business mailing address

1652 RIVER TRAIL RD
PIPE CREEK TX
78063-6099
US

V. Phone/Fax

Practice location:
  • Phone: 361-502-1315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT149011
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: