Provider Demographics
NPI:1396461489
Name:HORNBECK, PARKER BRITTEN II
Entity type:Individual
Prefix:
First Name:PARKER
Middle Name:BRITTEN
Last Name:HORNBECK
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 PANETTA RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93924-9452
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:58 PANETTA RD
Practice Address - Street 2:
Practice Address - City:CARMEL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93924-9452
Practice Address - Country:US
Practice Address - Phone:831-277-1077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5156-1863225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist