MEDICARE: MR. CHRISS D PARKS P.T.

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	225100000X	Physical Therapist	2066	CO
2	2251S0007X	Sports Physical Therapist	2066	CO
3	2251X0800X	Orthopedic Physical Therapist	2066	CO

General Provider Information

NPI Number	:	1790778652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISS D PARKS P.T.

Provider Business Mailing Address
First Line	:	PO BOX 775842
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80477-5842
Country	:	US
Telephone Number	:	970-879-8133
Fax Number	:	970-879-6481

Provider Business Practice Location Address
First Line	:	100 PARK AVE
Second Line	:	SUITE 101
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-5012
Country	:	US
Telephone Number	:	970-879-8133
Fax Number	:	970-879-6481

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	10/03/2007

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