MEDICARE: JONATHAN RYAN PARKER 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	5501010837	MI

General Provider Information

NPI Number	:	1922127463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN RYAN PARKER P.T.

Provider Business Mailing Address
First Line	:	1800 W US 223
Second Line	:	SUITE 100
City	:	ADRIAN
State	:	MI
Zip	:	49221-8439
Country	:	US
Telephone Number	:	517-263-3378
Fax Number	:	517-263-4527

Provider Business Practice Location Address
First Line	:	1434 W CHICAGO BLVD.
Second Line	:
City	:	TECUMSEH
State	:	MI
Zip	:	49286-8727
Country	:	US
Telephone Number	:	517-563-3378
Fax Number	:	517-563-4527

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	10/07/2009

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