MEDICARE: LAUREN MARY PARLEY PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	63.001651	CT

General Provider Information

NPI Number	:	1073971743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN MARY PARLEY PTA

Provider Business Mailing Address
First Line	:	14 MAIN ST
Second Line	:
City	:	WINDSOR LOCKS
State	:	CT
Zip	:	06096-2307
Country	:	US
Telephone Number	:	860-386-0522
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 MAIN ST
Second Line	:
City	:	WINDSOR LOCKS
State	:	CT
Zip	:	06096-2307
Country	:	US
Telephone Number	:	860-386-0522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2016
Last Update Date	:	02/09/2016

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Directions to “ LAUREN MARY PARLEY PTA” Practice Location

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