Provider Demographics
NPI:1194066639
Name:PARRELL, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PARRELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4744 BLUE MOUNDS TRL
Mailing Address - Street 2:
Mailing Address - City:BLACK EARTH
Mailing Address - State:WI
Mailing Address - Zip Code:53515-9742
Mailing Address - Country:US
Mailing Address - Phone:608-767-3413
Mailing Address - Fax:
Practice Address - Street 1:4744 BLUE MOUNDS TRL
Practice Address - Street 2:
Practice Address - City:BLACK EARTH
Practice Address - State:WI
Practice Address - Zip Code:53515-9742
Practice Address - Country:US
Practice Address - Phone:608-767-3413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12254-146171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0000000000113436OtherMASSAGE THERAPIST