=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750458345
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARKER PHYSICAL THERAPY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2006
-----------------------------------------------------
Last Update Date | 04/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7615 COLONY RD STE 110
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28226-5018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-364-6793
-----------------------------------------------------
Fax | 704-364-3171
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7615 COLONY RD STE 110
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28226-5018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-364-6793
-----------------------------------------------------
Fax | 704-364-3171
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR, CPC
-----------------------------------------------------
Name | JUSTINE BAKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-364-6793
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 4819
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------