MEDICARE: DEL PARSONS

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	001576-1	NY

General Provider Information

NPI Number	:	1740751478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEL PARSONS

Provider Business Mailing Address
First Line	:	23 W GLANN RD
Second Line	:
City	:	APALACHIN
State	:	NY
Zip	:	13732-4026
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	157 ACKLEY AVE
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-2862
Country	:	US
Telephone Number	:	607-203-1803
Fax Number	:

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

Provider Enumeration Date	:	12/06/2018
Last Update Date	:	12/06/2018

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