Provider Demographics
NPI:1215745898
Name:PARKER, NICHOLAS (PT, DPT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:PARKER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E OSBORN RD APT 244
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5262
Mailing Address - Country:US
Mailing Address - Phone:385-333-2757
Mailing Address - Fax:
Practice Address - Street 1:5111 N SCOTTSDALE RD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-7076
Practice Address - Country:US
Practice Address - Phone:480-990-1379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-0339912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic