Provider Demographics
NPI:1992452569
Name:PARKS, MADISON MARGARET (PT, DPT)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:MARGARET
Last Name:PARKS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BLEECKER ST APT 411
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5381
Mailing Address - Country:US
Mailing Address - Phone:918-845-5110
Mailing Address - Fax:
Practice Address - Street 1:8651 JOHN T WHITE RD STE 121
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-2766
Practice Address - Country:US
Practice Address - Phone:817-542-0714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1357797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist