MEDICARE: MR. WOODROW T PARKER CMT

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	163WM1400X	Nurse Massage Therapist (NMT)	4219	CA
2	173C00000X	Reflexologist	4219	CA

General Provider Information

NPI Number	:	1215237615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WOODROW T PARKER CMT

Provider Business Mailing Address
First Line	:	10844 OTSEGO ST
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-3929
Country	:	US
Telephone Number	:	818-284-9251
Fax Number	:

Provider Business Practice Location Address
First Line	:	10844 OTSEGO ST
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-3929
Country	:	US
Telephone Number	:	818-284-9251
Fax Number	:

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

Provider Enumeration Date	:	11/01/2010
Last Update Date	:	11/01/2010

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