MEDICARE: MRS. CAMILLA CRUMP PARKER PT

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	9801	NC

General Provider Information

NPI Number	:	1811955750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAMILLA CRUMP PARKER PT

Provider Business Mailing Address
First Line	:	2586 HIGHWAY 17 SOUTH
Second Line	:	UNIT C&D
City	:	GARDEN CITY BEACH
State	:	SC
Zip	:	29576-6605
Country	:	US
Telephone Number	:	843-651-6565
Fax Number	:	843-651-6575

Provider Business Practice Location Address
First Line	:	2586 HIGHWAY 17 SOUTH
Second Line	:	UNIT C&D
City	:	GARDEN CITY BEACH
State	:	SC
Zip	:	29576-6605
Country	:	US
Telephone Number	:	843-651-6565
Fax Number	:	843-651-6575

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	10/10/2011

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