Provider Demographics
NPI:1427355478
Name:PARKS, SUSAN C (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:PARKS
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 1:806 ADDISON CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6904
Mailing Address - Country:US
Mailing Address - Phone:757-486-8663
Mailing Address - Fax:
Practice Address - Street 1:2224 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4285
Practice Address - Country:US
Practice Address - Phone:757-486-8663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-26
Last Update Date:2011-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist