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General NPI Number Information
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NPI Number | 1255125902
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Entity Type | Individual
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Provider Name | MITCHELL DEON PARKER
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Gender | Male
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 10137 GRAND AVE # 60131
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City | FRANKLIN PARK
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State | IL
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Zip | 60131-2548
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Country | US
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Telephone | 847-451-7590
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Fax |
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Provider Business Mailing Address
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Address Line | 915 E WILLCOX AVE
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City | PEORIA
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State | IL
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Zip | 61603-2053
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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