Provider Demographics
NPI:1306950423
Name:PARKER, CHELSY B (P T)
Entity type:Individual
Prefix:MS
First Name:CHELSY
Middle Name:B
Last Name:PARKER
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 JORDAN ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4748
Mailing Address - Country:US
Mailing Address - Phone:318-222-8892
Mailing Address - Fax:318-222-8893
Practice Address - Street 1:663 JORDAN ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4748
Practice Address - Country:US
Practice Address - Phone:318-222-8892
Practice Address - Fax:318-222-8893
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06402225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1006858Medicaid
LA1599522OtherLA PROVIDER #
LA5CR78Medicare ID - Type Unspecified
LA4H597CR78Medicare UPIN