Provider Demographics
NPI:1306849062
Name:PARKHURST, ELIZABETH B (PT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:B
Last Name:PARKHURST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 862
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-0862
Mailing Address - Country:US
Mailing Address - Phone:580-327-0732
Mailing Address - Fax:580-327-0737
Practice Address - Street 1:427 BARNES AVE
Practice Address - Street 2:STE 2
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-2287
Practice Address - Country:US
Practice Address - Phone:580-327-0732
Practice Address - Fax:580-327-0737
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK73-1103617OtherFEDERAL E.I. NUMBER
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