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General NPI Number Information
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NPI Number | 1366726929
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Entity Type | Individual
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Provider Name | CHRISTOPHER B PARKER ATC, EMT-B
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Gender | Male
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Dates
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Enumeration Date | 09/30/2011
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Last Update Date | 09/30/2011
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Provider Practice Location Address
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Address Line | 200 PROSPECT ST EAST STROUDSBURG UNIVERSITY
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-2956
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Country | US
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Telephone | 724-601-4699
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Fax |
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Provider Business Mailing Address
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Address Line | 401 JAMISON AVE APT. B
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City | ELLWOOD CITY
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State | PA
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Zip | 16117-2566
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Country | US
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Telephone | 724-601-4699
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT005067
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License Number State | PA
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