Provider Demographics
NPI:1063935856
Name:PARKISON, CARLEY JANE MURDOCK (ATC)
Entity type:Individual
Prefix:MRS
First Name:CARLEY
Middle Name:JANE MURDOCK
Last Name:PARKISON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:CARLEY
Other - Middle Name:JANE
Other - Last Name:MURDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:2651 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-6374
Mailing Address - Country:US
Mailing Address - Phone:352-391-8779
Mailing Address - Fax:
Practice Address - Street 1:1076 RIBAUT RD STE 102
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5490
Practice Address - Country:US
Practice Address - Phone:843-521-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer