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General NPI Number Information
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NPI Number | 1356561997
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Entity Type | Individual
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Provider Name | KIMBERLY PARKER P.T.
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Gender | Female
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 22 UPPER MAIN ST SUITE 7
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City | SHARON
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State | CT
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Zip | 06069-2083
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Country | US
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Telephone | 860-364-9840
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Fax | 860-364-1859
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Provider Business Mailing Address
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Address Line | 26 VALLEY RD
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City | LAKEVILLE
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State | CT
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Zip | 06039-2120
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 003087
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License Number State | CT
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