Provider Demographics
NPI:1427446731
Name:PAREL, ROBERICK MARTY
Entity type:Individual
Prefix:
First Name:ROBERICK MARTY
Middle Name:
Last Name:PAREL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MARTY
Other - Middle Name:
Other - Last Name:PAREL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AT
Mailing Address - Street 1:1645 E THOMAS RD
Mailing Address - Street 2:APT 1028
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7631
Mailing Address - Country:US
Mailing Address - Phone:928-897-1758
Mailing Address - Fax:
Practice Address - Street 1:1833 W SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4822
Practice Address - Country:US
Practice Address - Phone:480-461-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer