Provider Demographics
NPI:1215681259
Name:PARKER, HALEY GRACE (DPT)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:GRACE
Last Name:PARKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S VILLA SAN MARCO DR UNIT 305
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4136
Mailing Address - Country:US
Mailing Address - Phone:706-741-8706
Mailing Address - Fax:
Practice Address - Street 1:360 PALM COAST PKWY NE
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3805
Practice Address - Country:US
Practice Address - Phone:386-446-4101
Practice Address - Fax:386-447-2161
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT38333208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT38333OtherDEPARTMENT OF HEALTH LICENSE