Provider Demographics
NPI:1285910620
Name:PARKER, FRANK M IV (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:M
Last Name:PARKER
Suffix:IV
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BONHAM ST
Mailing Address - Street 2:
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979-2603
Mailing Address - Country:US
Mailing Address - Phone:361-550-3437
Mailing Address - Fax:
Practice Address - Street 1:201 SANDCRAB BLVD
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-2424
Practice Address - Country:US
Practice Address - Phone:361-551-2698
Practice Address - Fax:361-551-2638
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT13112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer