Provider Demographics
NPI:1215237615
Name:PARKER, WOODROW T (CMT)
Entity type:Individual
Prefix:MR
First Name:WOODROW
Middle Name:T
Last Name:PARKER
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10844 OTSEGO ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-3929
Mailing Address - Country:US
Mailing Address - Phone:818-284-9251
Mailing Address - Fax:
Practice Address - Street 1:10844 OTSEGO ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-3929
Practice Address - Country:US
Practice Address - Phone:818-284-9251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4219163WM1400X, 173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)