Healthcare Provider Details

I. General information

NPI: 1407492697
Provider Name (Legal Business Name): THERESA PARRISH CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 EARL L CORE RD
MORGANTOWN WV
26505-5889
US

IV. Provider business mailing address

1601 EARL L CORE RD
MORGANTOWN WV
26505-5889
US

V. Phone/Fax

Practice location:
  • Phone: 304-296-7721
  • Fax:
Mailing address:
  • Phone: 42-696-7721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: