Provider Demographics
NPI:1144354598
Name:PARKER, MEREDY (PT)
Entity type:Individual
Prefix:MS
First Name:MEREDY
Middle Name:
Last Name:PARKER
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 1:3729 N. MAGNOLIA
Mailing Address - Street 2:#1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613
Mailing Address - Country:US
Mailing Address - Phone:773-857-6773
Mailing Address - Fax:
Practice Address - Street 1:3548 N. SOUTHPORT AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:66057-1436
Practice Address - Country:US
Practice Address - Phone:773-755-9214
Practice Address - Fax:773-755-9216
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-09700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK12892Medicare ID - Type Unspecified
ILQ30320Medicare UPIN