=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265569396
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARROTT ASSOCIATES PHYSTHERAP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2007
-----------------------------------------------------
Last Update Date | 03/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 E ORANGEBURG AVE SUITE E
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95350-5355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-548-0662
-----------------------------------------------------
Fax | 209-548-0663
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 E ORANGEBURG AVE SUITE E
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95350-5355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-548-0662
-----------------------------------------------------
Fax | 209-548-0663
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | MR. PHILIP ERIC PARROTT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 209-548-0662
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | PT18810
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------