Provider Demographics
NPI:1528072196
Name:PARKS, JASON CURTIS (LAT, ATC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:CURTIS
Last Name:PARKS
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 N FLEMING ST
Mailing Address - Street 2:APT. #4
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-3279
Mailing Address - Country:US
Mailing Address - Phone:620-276-4481
Mailing Address - Fax:
Practice Address - Street 1:101 E FULTON ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5455
Practice Address - Country:US
Practice Address - Phone:620-275-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24004872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer