Provider Demographics
NPI:1538590914
Name:PARKS, SANDRA EVELYN (PT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:EVELYN
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:PO BOX 51322
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-5622
Mailing Address - Country:US
Mailing Address - Phone:270-777-9283
Mailing Address - Fax:270-777-1550
Practice Address - Street 1:181 W PROFESSIONAL PARK CT
Practice Address - Street 2:SUITE 1
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3250
Practice Address - Country:US
Practice Address - Phone:270-843-5300
Practice Address - Fax:270-843-5383
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist