Healthcare Provider Details

I. General information

NPI: 1972433548
Provider Name (Legal Business Name): ALEX BENTON PARKER LPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 THOMPSON ST
ASHLAND VA
23005-1128
US

IV. Provider business mailing address

918 N 25TH ST
RICHMOND VA
23223-6563
US

V. Phone/Fax

Practice location:
  • Phone: 804-798-3291
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306606885
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: